Provider Demographics
NPI:1265509079
Name:THE CYPRESS CENTER, A PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:THE CYPRESS CENTER, A PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-573-9553
Mailing Address - Street 1:860 VIA DE LA PAZ
Mailing Address - Street 2:SUITE B1
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-573-9553
Mailing Address - Fax:310-573-9533
Practice Address - Street 1:860 VIA DE LA PAZ
Practice Address - Street 2:SUITE B1
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272
Practice Address - Country:US
Practice Address - Phone:310-573-9553
Practice Address - Fax:310-573-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2014-05-12
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
CAW16387Medicare PIN