Provider Demographics
NPI:1043226665
Name:PHYSICIANS CHOICE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PHYSICIANS CHOICE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAURAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:310-309-3721
Mailing Address - Street 1:12217 SANTA MONICA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2589
Mailing Address - Country:US
Mailing Address - Phone:310-309-3721
Mailing Address - Fax:310-309-3724
Practice Address - Street 1:12217 SANTA MONICA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-309-3721
Practice Address - Fax:310-309-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ666372OtherBLUE SHIELDS PREF. PROV.
CA=========OtherBLUE CROSS NUMBER
CA=========OtherBLUE CROSS NUMBER