Provider Demographics
NPI:1881427516
Name:CONNECT PHYSICAL THERAPY AND WELLNESS INC
Entity type:Organization
Organization Name:CONNECT PHYSICAL THERAPY AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-488-5397
Mailing Address - Street 1:2621 E JACARANDA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6224
Mailing Address - Country:US
Mailing Address - Phone:714-485-9887
Mailing Address - Fax:949-216-5980
Practice Address - Street 1:6930 WARNER AVE STE 104
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5316
Practice Address - Country:US
Practice Address - Phone:714-485-9887
Practice Address - Fax:949-216-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty