Organization
PRIMITIVE THERAPY PHYSICAL THERAPY INC
Active
Organization
PRIMITIVE THERAPY PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB MATTHEW CALDWELL DPT (OWNER)
(949) 310-4276
Entity
Organization
Contact information
Practice address
22691 LAMBERT ST STE 520, LAKE FOREST, CA 92630-1614
(949) 310-4276
(888) 390-1433
Mailing address
22691 LAMBERT ST #520, LAKE FOREST, CA 92630-1614
(949) 310-4276
(888) 390-1433
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL344A
MEDICARE PTAN
CA
Enumeration date
08/11/2009
Last updated
12/07/2009
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