Provider Demographics
NPI:1497776512
Name:ISHCORP ENTERPRISES
Entity Type:Organization
Organization Name:ISHCORP ENTERPRISES
Other - Org Name:SYNERGY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:ISHII
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:714-596-0700
Mailing Address - Street 1:7451 WARNER AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5494
Mailing Address - Country:US
Mailing Address - Phone:714-596-0700
Mailing Address - Fax:714-596-0774
Practice Address - Street 1:7451 WARNER AVE
Practice Address - Street 2:STE. A
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5494
Practice Address - Country:US
Practice Address - Phone:714-596-0700
Practice Address - Fax:714-596-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64802ZOtherBLUE SHIELD
CAW18883Medicare ID - Type UnspecifiedMEDICARE GROUP#