Provider Demographics
NPI:1225009871
Name:VINCENT PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:VINCENT PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MOMT
Authorized Official - Phone:626-449-4347
Mailing Address - Street 1:2700 E FOOTHILL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3443
Mailing Address - Country:US
Mailing Address - Phone:626-449-4347
Mailing Address - Fax:626-449-4317
Practice Address - Street 1:2700 E FOOTHILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3443
Practice Address - Country:US
Practice Address - Phone:626-449-4347
Practice Address - Fax:626-449-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03532ZOtherBLUE SHIELD GROUP NUMBER
CAW18569Medicare PIN