Provider Demographics
NPI:1770511859
Name:ALISO PHYSICAL THERAPY & SPORTS MEDICINE, INC
Entity Type:Organization
Organization Name:ALISO PHYSICAL THERAPY & SPORTS MEDICINE, INC
Other - Org Name:ALISO VIEJO PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEINANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:949-448-0872
Mailing Address - Street 1:27432 ALISO CREEK RD
Mailing Address - Street 2:FIRST FLOOR SUITE 100
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5337
Mailing Address - Country:US
Mailing Address - Phone:949-448-0872
Mailing Address - Fax:949-448-0984
Practice Address - Street 1:27432 ALISO CREEK RD
Practice Address - Street 2:FIRST FLOOR SUITE 100
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5337
Practice Address - Country:US
Practice Address - Phone:949-448-0872
Practice Address - Fax:949-448-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14562Medicare ID - Type UnspecifiedMEDICARE GROUP ID