Provider Demographics
NPI:1164994810
Name:PHYSRECOVERY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PHYSRECOVERY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTAYANA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:909-371-6083
Mailing Address - Street 1:100 SPECTRUM CENTER DR STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4974
Mailing Address - Country:US
Mailing Address - Phone:949-800-8471
Mailing Address - Fax:
Practice Address - Street 1:100 SPECTRUM CENTER DR STE 900
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4974
Practice Address - Country:US
Practice Address - Phone:949-800-8471
Practice Address - Fax:949-988-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty