| |
1401 Avocado Ave # 808, Newport Beach, CA 92660-7720 | |
(949) 706-1001 | |
(949) 706-1002 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 1401 Avocado Ave # 808, Newport Beach, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1023353448 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PT14876 (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Ayako S Krum |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1306007208 PECOS PAC ID: 1658418090 Enrollment ID: I20120703000390 |
Mailing Address | Practice Location Address |
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1401 Avocado Ave # 808, Newport Beach, CA 92660-7720 Ph: (949) 706-1001 | 1401 Avocado Ave # 808, Newport Beach, CA 92660-7720 Ph: (949) 706-1001 |