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General NPI Number Information
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NPI Number | 1962097725
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Entity Type | Organization
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Legal Business Name | DANCEPREHAB PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 74 ICON
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City | LAKE FOREST
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State | CA
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Zip | 92610-3000
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Country | US
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Telephone | 909-542-8388
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SPECTRUM CENTER DR STE 900-256
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City | IRVINE
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State | CA
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Zip | 92618-4962
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Country | US
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Telephone | 949-800-8471
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DR. NOEL SANTAYANA
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Credential | PT, DPT
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Telephone | 909-542-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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