Provider Demographics
NPI:1689716128
Name:ADVANTAGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-584-6121
Mailing Address - Street 1:22865 LOUMONT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3936
Mailing Address - Country:US
Mailing Address - Phone:949-584-6121
Mailing Address - Fax:
Practice Address - Street 1:24551 RAYMOND WAY STE 265
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4478
Practice Address - Country:US
Practice Address - Phone:949-305-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty