Provider Demographics
NPI:1982893822
Name:MARIA THERESA BAYLON-D'SOUZA
Entity Type:Organization
Organization Name:MARIA THERESA BAYLON-D'SOUZA
Other - Org Name:FLEX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLON-DSOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:949-429-3220
Mailing Address - Street 1:29542 CROWN CRK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7803
Mailing Address - Country:US
Mailing Address - Phone:949-429-3220
Mailing Address - Fax:949-429-3885
Practice Address - Street 1:27136 PASEO ESPADA # B
Practice Address - Street 2:SUITE 1103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2728
Practice Address - Country:US
Practice Address - Phone:949-429-3220
Practice Address - Fax:949-429-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15279Medicare PIN