Provider Demographics
NPI:1093773640
Name:LAGUNA HILLS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LAGUNA HILLS PHYSICAL THERAPY INC
Other - Org Name:LAGUNA HILLS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:949-830-6220
Mailing Address - Street 1:25431 CABOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5526
Mailing Address - Country:US
Mailing Address - Phone:949-830-6220
Mailing Address - Fax:949-830-6227
Practice Address - Street 1:25431 CABOT RD STE 101
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5526
Practice Address - Country:US
Practice Address - Phone:949-830-6220
Practice Address - Fax:949-830-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20444Medicare PIN