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General NPI Number Information
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NPI Number | 1942507256
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Entity Type | Organization
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Legal Business Name | ACTIVE REHABILITATION AND CONDITIONING PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 4880 IRVINE BLVD SUITE # 102
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City | IRVINE
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State | CA
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Zip | 92620-1963
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Country | US
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Telephone | 714-486-5392
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Fax |
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Provider Business Mailing Address
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Address Line | 38 SHAMAN
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City | IRVINE
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State | CA
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Zip | 92618-8810
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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 | OWNER
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Name | MATTHEW SCHATZ
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Credential |
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Telephone | 949-378-7347
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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 |
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License Number State |
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