Healthcare Provider Details

I. General information

NPI: 1700199106
Provider Name (Legal Business Name): WELLNESS RX PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23721 CALLE GANADOR
MISSION VIEJO CA
92691-3228
US

IV. Provider business mailing address

23721 CALLE GANADOR
MISSION VIEJO CA
92691-3228
US

V. Phone/Fax

Practice location:
  • Phone: 949-306-3602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number27505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number27505
License Number StateCA

VIII. Authorized Official

Name: MR. CHRISTOPHER MARC ACKERMAN
Title or Position: PRESIDENT
Credential: D.P.T., P.C.S.
Phone: 949-306-3602