Organization
NEW LIGHT PHYSICAL THERAPY AND WELLNESS CENTER INC.
Active
Organization
NEW LIGHT PHYSICAL THERAPY AND WELLNESS CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALI ETESSAM DPT (CEO)
(949) 878-6792
Entity
Organization
Contact information
Practice address
62 CORPORATE PARK, SUITE # 235, IRVINE, CA 92606-3122
(949) 878-6792
Mailing address
3 CORPORATE PARK STE 165, IRVINE, CA 92606-5161
(949) 878-6792
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
20329
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558403733
NPI INDIVIDUAL
CA
Enumeration date
04/15/2014
Last updated
09/16/2021
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