Provider Demographics
NPI:1639237167
Name:J.G. PERFORMANCE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:J.G. PERFORMANCE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:GEURTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-530-4184
Mailing Address - Street 1:11022 ACACIA PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5108
Mailing Address - Country:US
Mailing Address - Phone:714-530-4184
Mailing Address - Fax:714-530-4096
Practice Address - Street 1:11022 ACACIA PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5108
Practice Address - Country:US
Practice Address - Phone:714-530-4184
Practice Address - Fax:714-530-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty