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Organization
SOUTHSIDE PHYSICAL THERAPY AND SPORTS CENTER
Active
Organization
SOUTHSIDE PHYSICAL THERAPY AND SPORTS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR RAMON CARLOS DPT (PRESIDENT)
(714) 965-2222
Entity
Organization
Contact information
Practice address
22311 BROOKHURST ST STE 104, HUNTINGTON BEACH, CA 92646-8458
(714) 965-2222
(714) 965-2224
Mailing address
22311 BROOKHURST ST STE 104, HUNTINGTON BEACH, CA 92646-8458
(714) 965-2222
(714) 965-2224
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT26966
CA
Other
Enumeration date
12/07/2011
Last updated
12/07/2011
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