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General NPI Number Information
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NPI Number | 1033142013
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Entity Type | Organization
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Legal Business Name | SPINE AND SPORT PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 32261 CAMINO CAPISTRANO SUITE D101
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3746
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Country | US
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Telephone | 949-429-2155
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Fax | 949-429-2151
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Provider Business Mailing Address
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Address Line | 32261 CAMINO CAPISTRANO SUITE D101
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3746
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Country | US
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Telephone | 949-429-2155
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Fax | 949-429-2151
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | PAUL BATCHELOR
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Credential |
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Telephone | 949-429-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CA27078
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License Number State | CA
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