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Organization
REPAIR PHYSICAL THERAPY INC.
Active
Organization
REPAIR PHYSICAL THERAPY INC.
Active
Parent organization
REPAIR PHYSICAL THERAPY INC
Other names
Repair Sports Institute
Organization subpart
Yes
Provider details
NPI number
Legal business name
REPAIR PHYSICAL THERAPY INC
Authorized official
CHAD BEAUCHAMP (OWNER/ DPT)
(310) 721-1082
Entity
Organization
Contact information
Practice address
20311 SW BIRCH ST STE 150, NEWPORT BEACH, CA 92660-1779
(949) 272-1030
Mailing address
16561 BOLSA CHICA ST STE 107, HUNTINGTON BEACH, CA 92649-3574
(714) 377-4314
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
38002
CA
2251S0007X
Sports Physical Therapist
38002
CA
2251X0800X
Orthopedic Physical Therapist
38002
CA
Other
Enumeration date
03/29/2017
Last updated
03/29/2017
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