Provider Demographics
NPI:1548271679
Name:EIRICH, BRETT STEVEN (PT)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:STEVEN
Last Name:EIRICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18102 IRVINE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-505-2966
Mailing Address - Fax:714-505-2976
Practice Address - Street 1:18102 IRVINE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-505-2966
Practice Address - Fax:714-505-2976
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT14722AMedicare ID - Type Unspecified