Healthcare Provider Details

I. General information

NPI: 1255446860
Provider Name (Legal Business Name): CARLSON PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 YELLOWPINE LN
TRABUCO CANYON CA
92679-1420
US

IV. Provider business mailing address

8 YELLOWPINE LN
TRABUCO CANYON CA
92679-1420
US

V. Phone/Fax

Practice location:
  • Phone: 949-713-7939
  • Fax:
Mailing address:
  • Phone: 949-713-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number19033
License Number StateCA

VIII. Authorized Official

Name: MR. TIMOTHY JAMES CARLSON
Title or Position: PRESIDENT
Credential: PT
Phone: 949-713-7939