Provider Demographics
NPI:1134657299
Name:CORE TOTAL BODY PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:CORE TOTAL BODY PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:REEKSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:714-870-8405
Mailing Address - Street 1:PO BOX 956
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92871-0956
Mailing Address - Country:US
Mailing Address - Phone:714-223-0110
Mailing Address - Fax:714-223-0115
Practice Address - Street 1:1027 N HARBOR BLVD # B
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1310
Practice Address - Country:US
Practice Address - Phone:714-870-8478
Practice Address - Fax:714-870-8405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REEKSTIN ENTERPRISES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy