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General NPI Number Information
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NPI Number | 1104721257
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Entity Type | Organization
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Legal Business Name | ETHAN OSBORNE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 17871 SANTIAGO BLVD STE 205
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City | VILLA PARK
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State | CA
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Zip | 92861-4119
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Country | US
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Telephone | 714-464-7698
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Fax |
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Provider Business Mailing Address
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Address Line | 6601 VISTA LOMA
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City | YORBA LINDA
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State | CA
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Zip | 92886-6454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ETHAN GREGORY OSBORNE
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Credential | DPT
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Telephone | 949-278-1640
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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 |
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License Number State | NULL
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