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General NPI Number Information
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NPI Number | 1780565697
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Entity Type | Individual
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Provider Name | MARA FURNISH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 140 S CHAPARRAL CT STE 160
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City | ANAHEIM
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State | CA
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Zip | 92808-2283
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Country | US
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Telephone | 714-794-5889
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Fax |
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Provider Business Mailing Address
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Address Line | 114 LYDIA LN
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City | CORONA
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State | CA
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Zip | 92882-8524
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Country | US
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Telephone | 951-317-1458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 308492
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License Number State | CA
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