Provider Demographics
NPI:1164554911
Name:ONE ON ONE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ONE ON ONE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:LUCY
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPY
Authorized Official - Phone:714-334-1014
Mailing Address - Street 1:19891 BEACH BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3209
Mailing Address - Country:US
Mailing Address - Phone:714-536-4866
Mailing Address - Fax:714-536-4865
Practice Address - Street 1:7662 DANUBE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4639
Practice Address - Country:US
Practice Address - Phone:714-334-1014
Practice Address - Fax:209-780-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18207261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16930Medicare PIN