Provider Demographics
NPI:1225613169
Name:SMC PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:SMC PHYSICAL THERAPY, INC
Other - Org Name:SMC PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIONGBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:818-324-7681
Mailing Address - Street 1:8349 RESEDA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5912
Mailing Address - Country:US
Mailing Address - Phone:818-678-9052
Mailing Address - Fax:855-919-4380
Practice Address - Street 1:8349 RESEDA BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5912
Practice Address - Country:US
Practice Address - Phone:818-678-9052
Practice Address - Fax:855-919-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty