Provider Demographics
NPI:1033305164
Name:LAMONT PHYSICAL THERAPY-.
Entity Type:Organization
Organization Name:LAMONT PHYSICAL THERAPY-.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHELTON
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:661-845-0600
Mailing Address - Street 1:10130 MAIN ST
Mailing Address - Street 2:STE., A
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1740
Mailing Address - Country:US
Mailing Address - Phone:661-845-0600
Mailing Address - Fax:661-845-0640
Practice Address - Street 1:10130 MAIN ST
Practice Address - Street 2:STE., A
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1740
Practice Address - Country:US
Practice Address - Phone:661-845-0600
Practice Address - Fax:661-845-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT23092261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30539ZMedicare PIN