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General NPI Number Information
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NPI Number | 1164752473
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Entity Type | Organization
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Legal Business Name | CHANGE SPORTS PHYSICAL THERAPY INSTITUTE
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 7172 EDINGER AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3505
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Country | US
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Telephone | 714-902-9349
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Fax | 714-362-3147
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Provider Business Mailing Address
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Address Line | 7172 EDINGER AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3505
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Country | US
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Telephone | 714-902-9349
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Fax | 714-362-3147
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATT SWIFT
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Credential | P.T.
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Telephone | 714-902-9349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 33345
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License Number State | CA
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