Provider Demographics
NPI:1346266954
Name:REEKSTIN ENTERPRISES INC. DBA C.O.R.E. PHYSICAL THERAPY
Entity Type:Organization
Organization Name:REEKSTIN ENTERPRISES INC. DBA C.O.R.E. PHYSICAL THERAPY
Other - Org Name:CORE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:REEKSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-525-6486
Mailing Address - Street 1:1125 CERRITOS DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4019
Mailing Address - Country:US
Mailing Address - Phone:714-449-9965
Mailing Address - Fax:
Practice Address - Street 1:1027 N HARBOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1310
Practice Address - Country:US
Practice Address - Phone:714-870-8478
Practice Address - Fax:714-870-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26462261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17065OtherGROUP LEGACY
CAP79420Medicare UPIN
CAW17065OtherGROUP LEGACY