Provider Demographics
NPI:1891726840
Name:SOUTH COUNTY AQUATIC & PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH COUNTY AQUATIC & PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-364-6888
Mailing Address - Street 1:27882 FORBES RD # 100
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1219
Mailing Address - Country:US
Mailing Address - Phone:949-364-6888
Mailing Address - Fax:949-364-6333
Practice Address - Street 1:27882 FORBES RD # 100
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1219
Practice Address - Country:US
Practice Address - Phone:949-364-6888
Practice Address - Fax:949-364-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty