Provider Demographics
NPI:1982930392
Name:NATURAL HEALTH SPORTS THERAPY INC
Entity type:Organization
Organization Name:NATURAL HEALTH SPORTS THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:949-645-4086
Mailing Address - Street 1:1784 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2756
Mailing Address - Country:US
Mailing Address - Phone:949-645-4086
Mailing Address - Fax:949-645-2014
Practice Address - Street 1:1784 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2756
Practice Address - Country:US
Practice Address - Phone:949-645-4086
Practice Address - Fax:949-645-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy