Provider Demographics
NPI:1780565697
Name:FURNISH, MARA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:FURNISH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LYDIA LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8524
Mailing Address - Country:US
Mailing Address - Phone:951-317-1458
Mailing Address - Fax:
Practice Address - Street 1:140 S CHAPARRAL CT STE 160
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2283
Practice Address - Country:US
Practice Address - Phone:714-794-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3084922251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics