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General NPI Number Information
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NPI Number | 1346706025
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Entity Type | Organization
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Legal Business Name | IMPACT PHYSICAL THERAPY AND PERFORMANCE, P.C.
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 34 SERENITY LN
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5905
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Country | US
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Telephone | 949-378-9985
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Fax |
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Provider Business Mailing Address
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Address Line | 34 SERENITY LN
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5905
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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 - PHYSICAL THERAPIST
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Name | KEVIN JOHN O'CONNOR
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Credential | PT, DPT, OCS
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Telephone | 949-378-9985
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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 |
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License Number State |
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