Organization
IMPACT REHABILITATION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIS MARK SUTCLIFF MPT, ATC (PRESIDENT)
(714) 288-9125
Entity
Organization
Contact information
Practice address
255 N TUSTIN ST, ORANGE, CA 92867-7772
(714) 288-9125
(714) 288-9129
Mailing address
PO BOX 5986, ORANGE, CA 92863-5986
(714) 288-9125
(714) 288-9129
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT26858
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001400
—
CA
Enumeration date
07/23/2006
Last updated
03/30/2020
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