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General NPI Number Information
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NPI Number | 1427678861
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Entity Type | Organization
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Legal Business Name | SURF AND TURF THERAPY
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 31441 AVENIDA DE LA VIS
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2401
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Country | US
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Telephone | 949-312-7227
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Fax |
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Provider Business Mailing Address
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Address Line | 31441 AVENIDA DE LA VIS
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2401
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Country | US
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Telephone | 949-312-7227
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JILLIAN DANIELLE STEWART
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Credential | PT, DPT, HPCS
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Telephone | 616-403-3848
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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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