Provider Demographics
NPI:1528097482
Name:SUNSET PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:SUNSET PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:II
Authorized Official - Credentials:DOCTOR OF PHYSICAL T
Authorized Official - Phone:714-843-9077
Mailing Address - Street 1:5901 WARNER AVE
Mailing Address - Street 2:#418
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4659
Mailing Address - Country:US
Mailing Address - Phone:714-843-9077
Mailing Address - Fax:562-799-8832
Practice Address - Street 1:18800 MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-843-9077
Practice Address - Fax:562-799-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT24666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ004752OtherBLUE SHEILD OF CA
CAZZZ004752OtherBLUE SHEILD OF CA
CAW15156Medicare ID - Type Unspecified