Provider Demographics
NPI:1861982191
Name:IGNITE PHYZIOTHERAPY & ATHLETICS
Entity type:Organization
Organization Name:IGNITE PHYZIOTHERAPY & ATHLETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHDUL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:562-896-0129
Mailing Address - Street 1:1703 SHADY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1850
Mailing Address - Country:US
Mailing Address - Phone:562-896-0129
Mailing Address - Fax:
Practice Address - Street 1:41588 EASTMAN DR STE A
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7053
Practice Address - Country:US
Practice Address - Phone:951-223-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy