Provider Demographics
NPI:1255756680
Name:THINK PHYSICAL THERAPY
Entity type:Organization
Organization Name:THINK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-544-5565
Mailing Address - Street 1:365 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3108
Mailing Address - Country:US
Mailing Address - Phone:714-544-5565
Mailing Address - Fax:714-544-5570
Practice Address - Street 1:365 W 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3108
Practice Address - Country:US
Practice Address - Phone:714-544-5565
Practice Address - Fax:714-544-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty