Provider Demographics
NPI:1578861076
Name:JOHN M. SOMERNDIKE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:JOHN M. SOMERNDIKE PHYSICAL THERAPY, PC
Other - Org Name:ORANGE COAST ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:SOMERNDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-771-7047
Mailing Address - Street 1:1421 N WANDA RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5343
Mailing Address - Country:US
Mailing Address - Phone:714-771-7047
Mailing Address - Fax:714-912-4729
Practice Address - Street 1:1421 N WANDA RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5343
Practice Address - Country:US
Practice Address - Phone:714-771-7047
Practice Address - Fax:714-771-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27237261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy