Provider Demographics
NPI:1073666327
Name:FUNCTIONAL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:FUNCTIONAL PHYSICAL THERAPY, INC.
Other - Org Name:FUNCTIONAL PHYSICAL THERAPY AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:626-446-3862
Mailing Address - Street 1:150 N SANTA ANITA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3181
Mailing Address - Country:US
Mailing Address - Phone:626-446-3862
Mailing Address - Fax:626-446-3860
Practice Address - Street 1:150 N SANTA ANITA AVE STE 210
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3181
Practice Address - Country:US
Practice Address - Phone:626-446-3862
Practice Address - Fax:626-446-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CA261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15974Medicare ID - Type Unspecified