Provider Demographics
NPI:1720522972
Name:FULL SWING PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FULL SWING PHYSICAL THERAPY
Other - Org Name:FULL SWING PT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:ESCOBEDO
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:831-320-6634
Mailing Address - Street 1:21411 MORESBY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7284
Mailing Address - Country:US
Mailing Address - Phone:831-320-6634
Mailing Address - Fax:
Practice Address - Street 1:21411 MORESBY WAY
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7284
Practice Address - Country:US
Practice Address - Phone:831-320-6634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty