Provider Demographics
NPI:1457069650
Name:EMPOWERED ATHLETICS PHYSICAL THERAPY CO
Entity Type:Organization
Organization Name:EMPOWERED ATHLETICS PHYSICAL THERAPY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYNNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-584-7787
Mailing Address - Street 1:24 REGALO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5100
Mailing Address - Country:US
Mailing Address - Phone:949-584-7787
Mailing Address - Fax:
Practice Address - Street 1:16 TECHNOLOGY DR STE 169
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2328
Practice Address - Country:US
Practice Address - Phone:949-502-0951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty