Provider Demographics
NPI:1639679863
Name:TUSTIN PHYSICAL THERAPY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:TUSTIN PHYSICAL THERAPY SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RISHA
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:STROPLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:657-859-6458
Mailing Address - Street 1:19582 BEACH BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5924
Mailing Address - Country:US
Mailing Address - Phone:714-841-6162
Mailing Address - Fax:
Practice Address - Street 1:15000 KENSINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1821
Practice Address - Country:US
Practice Address - Phone:714-883-4972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty