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General NPI Number Information
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NPI Number | 1073695979
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY SERVICES OF ORANGE COUNTY, INC.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1525 MESA VERDE DR E SUITE #120
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City | COSTA MESA
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State | CA
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Zip | 92626-5218
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Country | US
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Telephone | 714-427-0615
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Fax | 714-427-0617
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Provider Business Mailing Address
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Address Line | 1525 MESA VERDE DR E SUITE #120
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City | COSTA MESA
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State | CA
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Zip | 92626-5218
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Country | US
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Telephone | 714-427-0615
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Fax | 714-427-0617
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MRS. SHARON JO GRADY
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Credential | PT, MS, PCS
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Telephone | 714-427-0615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT1222
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License Number State | CA
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