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General NPI Number Information
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NPI Number | 1275551988
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Entity Type | Organization
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Legal Business Name | EAGLE PHYSICAL THERAPY OF HUNTINGTON BEACH
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 19891 BEACH BLVD SUITE 105
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-3209
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Country | US
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Telephone | 714-536-9700
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Fax | 714-536-9701
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Provider Business Mailing Address
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Address Line | 19891 BEACH BLVD SUITE 105
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-3209
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Country | US
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Telephone | 714-536-9700
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Fax | 714-536-9701
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KEITH R. STROTHER
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Credential | PT
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Telephone | 714-536-9700
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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 | 13554
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License Number State | CA
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