Provider Demographics
NPI:1558508036
Name:PTRD, INC.
Entity Type:Organization
Organization Name:PTRD, INC.
Other - Org Name:PREMIERE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SIEU
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:415-367-5323
Mailing Address - Street 1:151 KINGS CYN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1913
Mailing Address - Country:US
Mailing Address - Phone:949-559-5362
Mailing Address - Fax:
Practice Address - Street 1:23422 MILL CREEK DR
Practice Address - Street 2:# 220
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1688
Practice Address - Country:US
Practice Address - Phone:949-900-1300
Practice Address - Fax:949-900-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25344261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy