Provider Demographics
NPI:1255654398
Name:LADERA RANCH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LADERA RANCH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-754-1344
Mailing Address - Street 1:777 CORPORATE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2135
Mailing Address - Country:US
Mailing Address - Phone:949-472-2242
Mailing Address - Fax:949-472-4501
Practice Address - Street 1:777 CORPORATE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2135
Practice Address - Country:US
Practice Address - Phone:949-472-2242
Practice Address - Fax:949-472-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14763Medicare PIN