Organization
SPECTRUM THERAPY AND SPORTS PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARC LARSON RPT (OWNER)
(949) 595-0700
Entity
Organization
Contact information
Practice address
16 TECHNOLOGY DR STE 169, IRVINE, CA 92618-2328
(949) 595-0700
(949) 595-0797
Mailing address
16 TECHNOLOGY DR STE 169, IRVINE, CA 92618-2328
(949) 595-0700
(949) 595-0797
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
PT24951
CA
261QP2000X
Physical Therapy Clinic/Center
Primary
PT33089
CA
Other
Enumeration date
05/30/2007
Last updated
02/13/2008
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