Provider Demographics
NPI:1457430688
Name:SIGNATURE PHYSICAL THERAPY P C
Entity type:Organization
Organization Name:SIGNATURE PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-481-0015
Mailing Address - Street 1:1393 CALLE AVANZADO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6351
Mailing Address - Country:US
Mailing Address - Phone:949-481-0015
Mailing Address - Fax:949-481-5611
Practice Address - Street 1:1393 CALLE AVANZADO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6351
Practice Address - Country:US
Practice Address - Phone:949-481-0015
Practice Address - Fax:949-481-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19207Medicare ID - Type UnspecifiedGROUP ID