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General NPI Number Information
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NPI Number | 1417355793
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Entity Type | Organization
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Legal Business Name | ENVISION SPORT PHYSICAL THERAPY & PILATES
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 23121 ANTONIO PKWY SUITE 100
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2658
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Country | US
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Telephone | 949-713-6445
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Fax | 949-713-6488
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Provider Business Mailing Address
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Address Line | 23121 ANTONIO PKWY SUITE 100
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2658
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Country | US
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Telephone | 949-713-6445
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Fax | 949-713-6488
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Authorized Official
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Title or Position | SECRETARY
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Name | DARRIN YEE
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Credential |
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Telephone | 949-713-6445
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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 |
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License Number State |
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