Provider Demographics
NPI:1730411604
Name:PHYSICAL THERAPY CENTER, INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HERZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-754-1344
Mailing Address - Street 1:25982 PALA
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6719
Mailing Address - Country:US
Mailing Address - Phone:949-582-0125
Mailing Address - Fax:949-582-0261
Practice Address - Street 1:25982 PALA
Practice Address - Street 2:SUITE 230
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6719
Practice Address - Country:US
Practice Address - Phone:949-582-0125
Practice Address - Fax:949-582-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14763Medicare PIN