Provider Demographics
NPI:1841330701
Name:PHYSICAL THERAPY OF NEWPORT, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF NEWPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFFAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-673-2893
Mailing Address - Street 1:747 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6927
Mailing Address - Country:US
Mailing Address - Phone:949-673-2893
Mailing Address - Fax:
Practice Address - Street 1:747 DOVER DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6927
Practice Address - Country:US
Practice Address - Phone:949-673-2893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24789261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT24789AMedicare PIN