Provider Demographics
NPI:1659645604
Name:HANCOCK, DUSTIN COREY (DPT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:COREY
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31878 DEL OBISPO ST STE 118-426
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3223
Mailing Address - Country:US
Mailing Address - Phone:949-298-5403
Mailing Address - Fax:949-312-2856
Practice Address - Street 1:31896 PLAZA DR STE E3
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3724
Practice Address - Country:US
Practice Address - Phone:949-312-2485
Practice Address - Fax:949-312-2856
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist