Provider Demographics
NPI:1912245432
Name:J.F.SHEA THERAPEUTIC RIDING CENTER
Entity Type:Organization
Organization Name:J.F.SHEA THERAPEUTIC RIDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-240-8441
Mailing Address - Street 1:26284 OSO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1629
Mailing Address - Country:US
Mailing Address - Phone:949-240-8441
Mailing Address - Fax:949-240-3447
Practice Address - Street 1:26284 OSO RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1629
Practice Address - Country:US
Practice Address - Phone:949-240-8441
Practice Address - Fax:949-240-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20001225100000X
CA5466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty