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Organization
GENESIS SPORTS PERFORMANCE INC
Active
Organization
GENESIS SPORTS PERFORMANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CAMPBELL PT (OWNER/PHYSICAL THERAPIST)
(949) 838-6686
Entity
Organization
Contact information
Practice address
22600 LAMBERT ST STE 1204F, LAKE FOREST, CA 92630-1623
(949) 838-6686
Mailing address
22600 LAMBERT ST STE 1204F, LAKE FOREST, CA 92630-1623
(949) 838-6686
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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