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General NPI Number Information
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NPI Number | 1164668141
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Entity Type | Organization
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Legal Business Name | OUTCOMES PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 05/17/2009
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Provider Practice Location Address
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Address Line | 760 WASHBURN AVE STE 2
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City | CORONA
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State | CA
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Zip | 92882-3303
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Country | US
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Telephone | 951-371-1233
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Fax | 951-371-1273
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Provider Business Mailing Address
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Address Line | 5255 WILLOW WALK RD
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City | OCEANSIDE
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State | CA
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Zip | 92057-1925
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Country | US
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Telephone | 760-687-3541
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Fax | 760-529-9292
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Authorized Official
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Title or Position | CEO
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Name | MR. ALEXANDER BASA
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Credential | P.T.
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Telephone | 760-687-3541
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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 | PT28665
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License Number State | CA
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