Provider Demographics
NPI:1427678861
Name:SURF AND TURF THERAPY
Entity type:Organization
Organization Name:SURF AND TURF THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, HPCS
Authorized Official - Phone:616-403-3848
Mailing Address - Street 1:31441 AVENIDA DE LA VIS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2401
Mailing Address - Country:US
Mailing Address - Phone:949-312-7227
Mailing Address - Fax:
Practice Address - Street 1:31441 AVENIDA DE LA VIS
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2401
Practice Address - Country:US
Practice Address - Phone:949-312-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy