Forever Young Rehabilitation LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

FOREVER YOUNG REHABILITATION LLC

Practice address

1600 W Coast Hwy Ste E
Newport Beach, CA 92663-5000

Phone

(949) 272-3325

Fax

(949) 333-2962

NPI assigned

Apr 21, 2022

Last updated

Sep 25, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samer Theodory

Title

Owner

Phone

(949) 272-3325

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664064000000",
    "number": "1518601012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W COAST HWY STE E",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926635000",
            "telephone_number": "949-272-3325",
            "fax_number": "949-333-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W COAST HWY STE E",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926635000",
            "telephone_number": "949-272-3325",
            "fax_number": "949-333-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER YOUNG REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-09-25",
        "certification_date": "2022-09-25",
        "status": "A",
        "authorized_official_last_name": "THEODORY",
        "authorized_official_first_name": "SAMER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-272-3325"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaciel Bicaldo Forbes
• Kyre Gwendolyn Forcen
• Julianna Foreman
• Tanya Jeanette Foreman, M.D.
• Forever Young Physical Therapy PC
• Jean Irene Forman, MD
• Kristen Carter Forman, M.D.
• Scott Kevin Forman, M.D.
• Todd Andrew Forman, M.D.
• Foroutan Dentistry, Inc (Newport Beach Dentistry)

• Physical Medicine & Rehabilitation Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.