Provider Demographics
NPI:1104301258
Name:ACCELERATE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:ACCELERATE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR, MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:949-502-3388
Mailing Address - Street 1:1600 DOVE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2438
Mailing Address - Country:US
Mailing Address - Phone:949-502-3388
Mailing Address - Fax:949-502-3304
Practice Address - Street 1:1600 DOVE ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2438
Practice Address - Country:US
Practice Address - Phone:949-502-3388
Practice Address - Fax:949-502-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty