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NPI Code Detail

MEDICARE: JOHN P O'CONNOR PT

MEDICARE: JOHN P O'CONNOR PT
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
1225100000XPhysical TherapistPT10045CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W15276OTHERCAMEDICARE GROUP
2W14553OTHERCAMEDICARE GROUP

General Provider Information

NPI Number : 1174517791
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN P O'CONNOR PT
Provider Business Mailing Address
First Line : 22521 AVENIDA EMPRESA STE 116
Second Line :
City : RANCHO SANTA MARGARITA
State : CA
Zip : 92688-2046
Country : US
Telephone Number : 949-766-8535
Fax Number : 949-766-8540
Provider Business Practice Location Address
First Line : 22521 AVENIDA EMPRESA STE 116
Second Line :
City : RANCHO SANTA MARGARITA
State : CA
Zip : 92688-2046
Country : US
Telephone Number : 949-766-8535
Fax Number : 949-766-8540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 10/07/2021

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