Provider Demographics
NPI:1699873661
Name:TOTAL BODY REHABILITATION INC
Entity type:Organization
Organization Name:TOTAL BODY REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:SLOSSON
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-249-2456
Mailing Address - Street 1:30301 GOLDEN LANTERN
Mailing Address - Street 2:SUITE B PURE PILATES TOTAL BODY REHAB
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-249-2456
Mailing Address - Fax:949-249-2365
Practice Address - Street 1:30301 GOLDEN LANTERN
Practice Address - Street 2:SUITE B PURE PILATES
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-249-2456
Practice Address - Fax:949-249-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247772081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18612Medicare ID - Type Unspecified