Healthcare Provider Details

I. General information

NPI: 1972680635
Provider Name (Legal Business Name): RICH COURY MPT, OCS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E. KATELLA AVE
ORANGE CA
92867
US

IV. Provider business mailing address

1659 N KLAMATH PL
ORANGE CA
92867-3252
US

V. Phone/Fax

Practice location:
  • Phone: 714-256-5075
  • Fax: 714-538-3128
Mailing address:
  • Phone: 714-745-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: