Provider Demographics
NPI:1518919638
Name:THERAPRO
Entity Type:Organization
Organization Name:THERAPRO
Other - Org Name:THERAPRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-492-7933
Mailing Address - Street 1:410 CALLE MACHO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-492-7933
Mailing Address - Fax:949-492-8636
Practice Address - Street 1:410 CALLE MACHO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-492-7933
Practice Address - Fax:949-492-8636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ETECH MILLENNIUM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT115512251G0304X
CAPT226442251G0304X
CAAT6605225200000X
CAAT5398225200000X
CAOT722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16405Medicare ID - Type Unspecified