Provider Demographics
NPI:1851346233
Name:PHASE THREE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PHASE THREE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOPPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:714-779-6969
Mailing Address - Street 1:4622 E LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1910
Mailing Address - Country:US
Mailing Address - Phone:714-779-6969
Mailing Address - Fax:714-779-6966
Practice Address - Street 1:4622 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1910
Practice Address - Country:US
Practice Address - Phone:714-779-6969
Practice Address - Fax:714-779-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19806Medicare ID - Type Unspecified