Provider Demographics
NPI:1881795375
Name:SCOR PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:SCOR PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-496-0122
Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-496-0122
Mailing Address - Fax:949-496-5027
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-496-0122
Practice Address - Fax:949-496-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14640Medicare ID - Type UnspecifiedGROUP ID NUMBER