Provider Demographics
NPI:1417355793
Name:ENVISION SPORT PHYSICAL THERAPY & PILATES
Entity type:Organization
Organization Name:ENVISION SPORT PHYSICAL THERAPY & PILATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-713-6445
Mailing Address - Street 1:23121 ANTONIO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2658
Mailing Address - Country:US
Mailing Address - Phone:949-713-6445
Mailing Address - Fax:949-713-6488
Practice Address - Street 1:23121 ANTONIO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2658
Practice Address - Country:US
Practice Address - Phone:949-713-6445
Practice Address - Fax:949-713-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy