| NPI | 1811529829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY PAYNE Manager 949-892-8644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2020-07-01 |