Provider Demographics
NPI:1174820146
Name:HOMESTRETCH P.T.
Entity Type:Organization
Organization Name:HOMESTRETCH P.T.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-338-0427
Mailing Address - Street 1:27525 PUERTA REAL
Mailing Address - Street 2:STE 100-224
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6379
Mailing Address - Country:US
Mailing Address - Phone:949-338-0427
Mailing Address - Fax:949-454-0031
Practice Address - Street 1:27525 PUERTA REAL
Practice Address - Street 2:STE 100-224
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6379
Practice Address - Country:US
Practice Address - Phone:949-338-0427
Practice Address - Fax:949-454-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT265172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26517AMedicare PIN