NPIMap

Organization Active NPI

Physical Therapy Center of Tustin, Inc

  • Physical Therapist
  • Tustin, CA
National Provider Identifier
1962601146
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT14722 Issued in CA
Legal business name
PHYSICAL THERAPY CENTER OF TUSTIN, INC
Practice address
18102 Irvine Blvd Ste 207
Tustin, CA 92780-3424
Phone
(714) 505-2966
Fax
(714) 505-2976
NPI assigned
Jul 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Authorized official

Name
Mr. Brett Steven Eirich, PT14722NPI 1548271679
Title
President
Phone
(714) 505-2966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT14722 CA Primary

Addresses

Primary practice location

18102 Irvine Blvd Ste 207
Tustin, CA 92780-3424

Mailing address

18102 Irvine Blvd Ste 207
Tustin, CA 92780-3424
Phone (714) 505-2966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060327000336 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9032127402 Receives reassigned benefits from 1 practitioner
Practice locations: Tustin, CA

National Provider Directory

National Provider Directory

Locations

18102 Irvine Blvd
Ste 207
Tustin, CA 92780
Phone (714) 505-2966

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1962601146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18102 IRVINE BLVD STE 207",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803424",
            "telephone_number": "714-505-2966",
            "fax_number": "714-505-2976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18102 IRVINE BLVD STE 207",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803424",
            "telephone_number": "714-505-2966",
            "fax_number": "714-505-2976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CENTER OF TUSTIN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "EIRICH",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-505-2966",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT14722"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.