Provider Demographics
NPI:1164527305
Name:MARINERS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MARINERS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-557-9292
Mailing Address - Street 1:201 SANDPOINTE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5778
Mailing Address - Country:US
Mailing Address - Phone:714-557-9292
Mailing Address - Fax:714-557-9137
Practice Address - Street 1:201 SANDPOINTE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5778
Practice Address - Country:US
Practice Address - Phone:714-557-9292
Practice Address - Fax:714-557-9137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14629OtherPTAN