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General NPI Number Information
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NPI Number | 1801230461
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Entity Type | Organization
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Legal Business Name | WEST COAST REHABILITATION SPECIALISTS PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 2682 WALNUT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-7006
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Country | US
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Telephone | 714-505-3200
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Fax | 714-505-3208
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Provider Business Mailing Address
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Address Line | 2682 WALNUT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-7006
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Country | US
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Telephone | 714-505-3200
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Fax | 714-505-3208
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | BRANDON BETHKE
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Credential |
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Telephone | 949-584-3728
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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 | PT36335
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License Number State | CA
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