Provider Demographics
NPI:1033299029
Name:PHYSICAL THERAPY CARE, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:URAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:310-348-8464
Mailing Address - Street 1:6214 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3801
Mailing Address - Country:US
Mailing Address - Phone:310-348-8464
Mailing Address - Fax:310-348-8470
Practice Address - Street 1:6214 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3801
Practice Address - Country:US
Practice Address - Phone:310-348-8464
Practice Address - Fax:310-348-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT29922AMedicare PIN
WPT29715AMedicare PIN
WOT2251AMedicare PIN
CAW15807Medicare ID - Type UnspecifiedGROUP NUMBER
CAWPT34275AMedicare PIN
CAWPT29922AMedicare PIN
WOT7320AMedicare PIN