Provider Demographics
NPI:1700498755
Name:WELL TO RUN PHYSICAL THERAPY & COACHING, INC.
Entity Type:Organization
Organization Name:WELL TO RUN PHYSICAL THERAPY & COACHING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS, NCPT
Authorized Official - Phone:949-554-4050
Mailing Address - Street 1:12 AMARANTE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-8929
Mailing Address - Country:US
Mailing Address - Phone:949-554-4050
Mailing Address - Fax:
Practice Address - Street 1:12 AMARANTE
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-8929
Practice Address - Country:US
Practice Address - Phone:949-554-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty