Provider Demographics
NPI:1578722823
Name:HOMEWORKS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:HOMEWORKS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CHIPOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MPT, MS, BS
Authorized Official - Phone:323-806-9096
Mailing Address - Street 1:2012 PHALAROPE CT
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4734
Mailing Address - Country:US
Mailing Address - Phone:714-580-2868
Mailing Address - Fax:714-241-1007
Practice Address - Street 1:2012 PHALAROPE CT
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4734
Practice Address - Country:US
Practice Address - Phone:714-580-2868
Practice Address - Fax:714-241-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29077261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548345960OtherPERSONAL NPI
CAPT29077Medicare PIN