Provider Demographics
NPI:1194920280
Name:SURINDER BRAR
Entity type:Organization
Organization Name:SURINDER BRAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-349-0911
Mailing Address - Street 1:26701 QUAIL CRK
Mailing Address - Street 2:263
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3002
Mailing Address - Country:US
Mailing Address - Phone:949-349-0911
Mailing Address - Fax:949-349-9472
Practice Address - Street 1:26701 QUAIL CRK
Practice Address - Street 2:263
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-3002
Practice Address - Country:US
Practice Address - Phone:949-349-0911
Practice Address - Fax:949-349-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6659261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT6659AMedicare ID - Type UnspecifiedPROVIDER NUMBER