Healthcare Provider Details

I. General information

NPI: 1154409688
Provider Name (Legal Business Name): JOAN TERRY PLEVIN PT, DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN TERRY PLEVIN D.C.

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22431 GOLDRUSH
LAKE FOREST CA
92630-4308
US

IV. Provider business mailing address

22431 GOLDRUSH
LAKE FOREST CA
92630-4308
US

V. Phone/Fax

Practice location:
  • Phone: 949-380-1445
  • Fax: 949-380-7723
Mailing address:
  • Phone: 949-380-1445
  • Fax: 949-380-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT7100
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT7100
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC16812
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC16812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: