Healthcare Provider Details

I. General information

NPI: 1548271679
Provider Name (Legal Business Name): BRETT STEVEN EIRICH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

18102 IRVINE BLVD SUITE 207
TUSTIN CA
92780
US

IV. Provider business mailing address

18102 IRVINE BLVD SUITE 207
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-505-2966
  • Fax: 714-505-2976
Mailing address:
  • Phone: 714-505-2966
  • Fax: 714-505-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: