Provider Demographics
NPI:1942507256
Name:ACTIVE REHABILITATION AND CONDITIONING PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACTIVE REHABILITATION AND CONDITIONING PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-378-7347
Mailing Address - Street 1:38 SHAMAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-8810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4880 IRVINE BLVD
Practice Address - Street 2:SUITE # 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1963
Practice Address - Country:US
Practice Address - Phone:714-486-5392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy