Provider Demographics
NPI:1043366073
Name:POLITO PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:POLITO PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:POLITO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:626-449-5005
Mailing Address - Street 1:39 CONGRESS ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3024
Mailing Address - Country:US
Mailing Address - Phone:626-449-5005
Mailing Address - Fax:626-449-5025
Practice Address - Street 1:39 CONGRESS ST
Practice Address - Street 2:SUITE 303
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3024
Practice Address - Country:US
Practice Address - Phone:626-449-5005
Practice Address - Fax:626-449-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64425ZOtherBLUE SHIELD GROUP NUMBER
CAZZZ64425ZOtherBLUE SHIELD GROUP NUMBER
CAZZZ64425ZOtherBLUE SHIELD GROUP NUMBER