Provider Demographics
| NPI: | 1457436578 |
|---|---|
| Name: | PHYSICAL RX PHYSICAL THERAPY, INC. |
| Entity Type: | Organization |
| Organization Name: | PHYSICAL RX PHYSICAL THERAPY, INC. |
| Other - Org Name: | PHYSICAL RX |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DEBORAH |
| Authorized Official - Middle Name: | ANN |
| Authorized Official - Last Name: | GRANGE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PT, DPT, OCS |
| Authorized Official - Phone: | 714-374-0233 |
| Mailing Address - Street 1: | 2130 MAIN ST STE 140 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HUNTINGTON BEACH |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92648-6441 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 714-374-0233 |
| Mailing Address - Fax: | 714-374-0244 |
| Practice Address - Street 1: | 2130 MAIN ST STE 140 |
| Practice Address - Street 2: | |
| Practice Address - City: | HUNTINGTON BEACH |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 92648-6441 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 714-374-0233 |
| Practice Address - Fax: | 714-374-0244 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-10-26 |
| Last Update Date: | 2023-05-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Multi-Specialty |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225600000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Dance Therapist | Group - Multi-Specialty | |
| No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | W15666 | Other | MEDICARE PTAN |
