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General NPI Number Information
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NPI Number | 1043816051
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Entity Type | Organization
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Legal Business Name | DEFINE WELLNESS AND PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 31896 PLAZA DR STE E3
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3724
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Country | US
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Telephone | 949-312-2485
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Fax | 949-312-2856
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Provider Business Mailing Address
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Address Line | 31878 DEL OBISPO ST STE 118-426
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3223
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Country | US
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Telephone | 949-312-2485
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Fax | 949-312-2856
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Authorized Official
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Title or Position | CEO
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Name | DUSTIN COREY HANCOCK
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Credential | PT, DPT
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Telephone | 949-298-5403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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