Healthcare Provider Details

I. General information

NPI: 1578861076
Provider Name (Legal Business Name): JOHN M. SOMERNDIKE PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N WANDA RD SUITE 160
ORANGE CA
92867-5343
US

IV. Provider business mailing address

1421 N WANDA RD SUITE 160
ORANGE CA
92867-5343
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-7047
  • Fax: 714-771-7051
Mailing address:
  • Phone: 714-771-7047
  • Fax: 714-912-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number27237
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN MASON SOMERNDIKE
Title or Position: CEO
Credential: DPT
Phone: 714-771-7047