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General NPI Number Information
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NPI Number | 1962684746
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Entity Type | Organization
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Legal Business Name | HOME STAR PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 39 CALLE LOYOLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-7018
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Country | US
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Telephone | 949-280-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 39 CALLE LOYOLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-7018
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Country | US
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Telephone | 949-280-4783
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Fax | 949-429-2319
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Authorized Official
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Title or Position | OFFICER
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Name | MR. JON PAUL MARCHESE
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Credential | P.T.
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Telephone | 949-280-4783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT17911
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License Number State | CA
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