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General NPI Number Information
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NPI Number | 1669839460
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Entity Type | Organization
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Legal Business Name | SUPERIOR PERFORMANCE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 4695 MACARTHUR CT SUITE 1100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1882
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Country | US
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Telephone | 949-423-6241
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Fax | 844-538-9597
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Provider Business Mailing Address
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Address Line | 4695 MACARTHUR CT SUITE 1100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1882
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Country | US
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Telephone | 949-423-6241
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Fax | 844-538-9597
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | DR. HEATHER BRITANY WHITING DEMIRCI
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Credential | PT, FFMT, FAAOMPT
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Telephone | 949-423-6241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 43596
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License Number State | CA
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