Provider Demographics
NPI:1861424194
Name:DANA POINT PHYSICAL THERAPY AND REHABILITATION, INC.
Entity type:Organization
Organization Name:DANA POINT PHYSICAL THERAPY AND REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-496-3896
Mailing Address - Street 1:34241 PACIFIC COAST HWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3845
Mailing Address - Country:US
Mailing Address - Phone:949-496-3896
Mailing Address - Fax:949-487-0277
Practice Address - Street 1:34241 PACIFIC COAST HWY
Practice Address - Street 2:STE. 102
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3845
Practice Address - Country:US
Practice Address - Phone:949-496-3896
Practice Address - Fax:949-487-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16955Medicare ID - Type UnspecifiedMEDICARE NUMBER