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General NPI Number Information
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NPI Number | 1881079259
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Entity Type | Organization
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Legal Business Name | COALITION PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 121 E 18TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3034
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Country | US
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Telephone | 408-781-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 121 E 18TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3034
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Country | US
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Telephone | 408-781-2511
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | STACEY LEE HALLARCES
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Credential | DPT
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Telephone | 408-781-2511
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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 | PT 39125
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License Number State | CA
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