Provider Demographics
NPI:1558658336
Name:JM PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:JM PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MESISCA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-915-4710
Mailing Address - Street 1:PO BOX 7379
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7379
Mailing Address - Country:US
Mailing Address - Phone:714-915-4710
Mailing Address - Fax:714-281-2238
Practice Address - Street 1:27765 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3762
Practice Address - Country:US
Practice Address - Phone:714-915-4710
Practice Address - Fax:714-281-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty