Provider Demographics
NPI:1184632374
Name:BIODYNAMICS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BIODYNAMICS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALEXA
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-424-0290
Mailing Address - Street 1:11100 WARNER CENTER DRIVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7506
Mailing Address - Country:US
Mailing Address - Phone:714-424-0290
Mailing Address - Fax:714-424-0278
Practice Address - Street 1:11100 WARNER CENTER DRIVE
Practice Address - Street 2:SUITE 218
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-424-0290
Practice Address - Fax:714-424-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX IDENTIFICATION