1558508036 NPI number — PTRD, INC.

Table of content: (NPI 1558508036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558508036 NPI number — PTRD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PTRD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREMIERE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558508036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 KINGS CYN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-559-5362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23422 MILL CREEK DR
Provider Second Line Business Practice Location Address:
# 220
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-1688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-900-1300
Provider Business Practice Location Address Fax Number:
949-900-1318
Provider Enumeration Date:
01/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
SIEU
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
415-367-5323

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  25344 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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