Healthcare Provider Details

I. General information

NPI: 1316288145
Provider Name (Legal Business Name): ART OF PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 ROBINSON DR
TUSTIN CA
92782-0905
US

IV. Provider business mailing address

387 ROBINSON DR
TUSTIN CA
92782-0905
US

V. Phone/Fax

Practice location:
  • Phone: 949-355-4790
  • Fax:
Mailing address:
  • Phone: 949-355-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 39293
License Number StateCA

VIII. Authorized Official

Name: DR. TREVOR NEAL D'SOUZA
Title or Position: OWNER
Credential: DPT
Phone: 949-355-4790