Provider Demographics
NPI:1487829933
Name:ADDISON, PAUL ROBERT JR (MPT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ROBERT
Last Name:ADDISON
Suffix:JR
Gender:M
Credentials:MPT, CSCS
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Mailing Address - Street 1:26941 CABOT RD
Mailing Address - Street 2:#103
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7030
Mailing Address - Country:US
Mailing Address - Phone:949-916-1402
Mailing Address - Fax:949-916-1403
Practice Address - Street 1:26941 CABOT RD
Practice Address - Street 2:#103
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7030
Practice Address - Country:US
Practice Address - Phone:949-916-1402
Practice Address - Fax:949-916-1403
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2009-02-20
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Provider Licenses
StateLicense IDTaxonomies
CA346022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic