=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588525083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CORE COLLECTION PHYSICAL THERAPY AND PILATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33161 CAMINO CAPISTRANO STE C
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-4826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-336-6346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 VISTA FIRENZE
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-336-6346
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | BREANNA VIKANDER
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 801-336-6346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------