Provider Demographics
NPI:1255367785
Name:BRAR, SURINDER P (PT)
Entity type:Individual
Prefix:MS
First Name:SURINDER
Middle Name:P
Last Name:BRAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LA MIRAGE CIR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5251
Mailing Address - Country:US
Mailing Address - Phone:949-349-0911
Mailing Address - Fax:949-349-9472
Practice Address - Street 1:36 LA MIRAGE CIR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5251
Practice Address - Country:US
Practice Address - Phone:949-349-0911
Practice Address - Fax:949-349-9472
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT66592251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT6659BMedicare PIN