Provider Demographics
NPI:1881003440
Name:RISING SUN PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:RISING SUN PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATSUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-274-9551
Mailing Address - Street 1:20301 SW ACACIA ST STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1741
Mailing Address - Country:US
Mailing Address - Phone:949-274-9551
Mailing Address - Fax:949-264-8219
Practice Address - Street 1:20301 SW ACACIA ST STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1741
Practice Address - Country:US
Practice Address - Phone:949-274-9551
Practice Address - Fax:949-264-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy