Provider Demographics
NPI:1801230461
Name:WEST COAST REHABILITATION SPECIALISTS PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:WEST COAST REHABILITATION SPECIALISTS PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-584-3728
Mailing Address - Street 1:2682 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7006
Mailing Address - Country:US
Mailing Address - Phone:714-505-3200
Mailing Address - Fax:714-505-3208
Practice Address - Street 1:2682 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7006
Practice Address - Country:US
Practice Address - Phone:714-505-3200
Practice Address - Fax:714-505-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36335261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy