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General NPI Number Information
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NPI Number | 1417267592
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Entity Type | Organization
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Legal Business Name | OAK STREET STUDIO AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1100 S COAST HWY SUITE 301 B
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2968
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Country | US
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Telephone | 949-494-3200
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Fax | 949-494-3222
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Provider Business Mailing Address
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Address Line | 1100 S COAST HWY STE 301B
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2970
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Country | US
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Telephone | 949-494-3200
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Fax | 949-494-3222
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | ERIN HOSIE JACKSON
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Credential | MS, PT, CPI
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Telephone | 949-307-7914
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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 | PT 20223
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License Number State | CA
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