Provider Demographics
NPI:1184669756
Name:PHYSICAL THERAPY INNOVATIONS, INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY INNOVATIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DIRECTOR, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:510-524-2177
Mailing Address - Street 1:425 KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3656
Mailing Address - Country:US
Mailing Address - Phone:510-524-2177
Mailing Address - Fax:510-525-2875
Practice Address - Street 1:425 KEARNEY ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3656
Practice Address - Country:US
Practice Address - Phone:510-524-2177
Practice Address - Fax:510-525-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-12-05
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
CAZZZ17602ZMedicare PIN