Healthcare Provider Details

I. General information

NPI: 1154327922
Provider Name (Legal Business Name): HAIRSTON & DALEY PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 N TUSTIN ST
ORANGE CA
92867-6006
US

IV. Provider business mailing address

1178 N TUSTIN ST
ORANGE CA
92867-6006
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-7790
  • Fax: 714-289-7786
Mailing address:
  • Phone: 714-289-7790
  • Fax: 714-289-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELANIE M EKLUND
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-289-7790