Provider Demographics
NPI:1083704738
Name:MILICH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MILICH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-445-0236
Mailing Address - Street 1:126 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3605
Mailing Address - Country:US
Mailing Address - Phone:626-445-0236
Mailing Address - Fax:626-445-2532
Practice Address - Street 1:126 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3605
Practice Address - Country:US
Practice Address - Phone:626-445-0236
Practice Address - Fax:626-445-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty