Provider Demographics
NPI:1316987274
Name:MARTIN ORTHOPEDIC REHABILITATION PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:MARTIN ORTHOPEDIC REHABILITATION PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-347-1021
Mailing Address - Street 1:27126 PASEO ESPADA STE 1621A
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6703
Mailing Address - Country:US
Mailing Address - Phone:949-347-1021
Mailing Address - Fax:949-347-0981
Practice Address - Street 1:27126 PASEO ESPADA STE 1621A
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6703
Practice Address - Country:US
Practice Address - Phone:949-347-1021
Practice Address - Fax:949-347-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT22377COtherPPIN
CAS81684Medicare UPIN
CAWPT22377COtherPPIN