MEDICARE: PHYSICAL THERAPY CENTER OF TUSTIN, INC

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	225100000X	Physical Therapist	PT14722	CA

General Provider Information

NPI Number	:	1962601146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY CENTER OF TUSTIN, INC

Provider Business Mailing Address
First Line	:	18102 IRVINE BLVD STE 207
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3424
Country	:	US
Telephone Number	:	714-505-2966
Fax Number	:	714-505-2976

Provider Business Practice Location Address
First Line	:	18102 IRVINE BLVD STE 207
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3424
Country	:	US
Telephone Number	:	714-505-2966
Fax Number	:	714-505-2976

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BRETT STEVEN EIRICH
Credential	:	PT14722
Telephone Number	:	714-505-2966

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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