MEDICARE: CHANGE SPORTS PHYSICAL THERAPY INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	33345	CA

General Provider Information

NPI Number	:	1164752473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGE SPORTS PHYSICAL THERAPY INSTITUTE

Provider Business Mailing Address
First Line	:	7172 EDINGER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3505
Country	:	US
Telephone Number	:	714-902-9349
Fax Number	:	714-362-3147

Provider Business Practice Location Address
First Line	:	7172 EDINGER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3505
Country	:	US
Telephone Number	:	714-902-9349
Fax Number	:	714-362-3147

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATT SWIFT
Credential	:	P.T.
Telephone Number	:	714-902-9349

Provider Enumeration Date	:	01/08/2010
Last Update Date	:	08/12/2025

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