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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