Costa Rehab and Wellness Clinic

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT37671 Issued in CA

Legal business name

COSTA REHAB AND WELLNESS CLINIC

Practice address

22821 Lake Forest Dr
Suite 115
Lake Forest, CA 92630-1606

Phone

(949) 716-5050

Fax

(949) 482-2122

NPI assigned

Aug 18, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Cary Costa, D.P.TNPI 1952690901

Title

Ceo

Phone

(971) 998-4484

Specialties & licenses 9

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cary Costa, D.P.T.

  • Orthopedic Physical Therapist
  • Lake Forest, CA
  • NPI 1952690901
  Authorized official Same address or phone

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

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1730588575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22821 LAKE FOREST DR",
            "address_2": "SUITE 115",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301606",
            "telephone_number": "949-716-5050",
            "fax_number": "949-482-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22821 LAKE FOREST DR",
            "address_2": "SUITE 115",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301606",
            "telephone_number": "949-716-5050",
            "fax_number": "949-482-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSTA REHAB AND WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-18",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "971-998-4484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.T"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251C2600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Cardiopulmonary",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251E1200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Ergonomics",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251H1200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Hand",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Neurology",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "CA",
            "license": "PT37671",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT37671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janis Marie Corbin, LCSW
• Alma Cornelio-Gomez
• Izelah Cornelio
• Eric Salvador Coronado
• Angel Cortez
• Cary Costa, D.P.T.
• Molly B Cote, M.S., CCC-SLP
• Coury & Buehler Physical Therapy - Lake Forest, Inc. (Coury & Buehler Physical Therapy - Lake Forest)
• Coury & Buehler Physical Therapy, Inc. (Coury & Buehler Physical Therapy - Lake Forest)
• Coury & Buehler Physical Therapy, Inc. (Coury & Buehler Physical Therapy)

• Orthopedic Physical Therapist in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Orthopedic Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; 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.