Provider Demographics
NPI:1578777223
Name:SOUTH ORANGE COUNTY PHYSICAL THERAPY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:SOUTH ORANGE COUNTY PHYSICAL THERAPY SPECIALISTS, INC.
Other - Org Name:SOCPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-597-0007
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:STE. 210
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3107
Mailing Address - Country:US
Mailing Address - Phone:949-597-0007
Mailing Address - Fax:949-597-0040
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:STE.210
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3107
Practice Address - Country:US
Practice Address - Phone:949-597-0007
Practice Address - Fax:949-597-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19136261QP2000X
CAAC 4386261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT18495AMedicare PIN
CAWPT19136AMedicare PIN
CAW20817Medicare PIN
CAWPT19079AMedicare PIN