Individual
BRENT A TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
871 S TUSTIN ST, ORANGE, CA 92866-3426
(714) 633-7227
Mailing address
871 S TUSTIN ST, ORANGE, CA 92866-3426
(408) 841-6777
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
294986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
294986
PHYSICAL THERAPY LICENSE
CA
Enumeration date
06/28/2018
Last updated
05/13/2024
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