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General NPI Number Information
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NPI Number | 1801223516
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Entity Type | Organization
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Legal Business Name | ACTIVE MOTION PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 22600 LAMBERT ST STE 1204
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City | LAKE FOREST
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State | CA
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Zip | 92630-1623
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Country | US
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Telephone | 949-533-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 22600 LAMBERT ST STE 1204
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City | LAKE FOREST
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State | CA
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Zip | 92630-1623
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SHAREHOLDER
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Name | JORDAN JESSE TURNER
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Credential | P.T.
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Telephone | 949-533-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT228100
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License Number State | CA
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