Provider Demographics
NPI:1407127152
Name:REHABILITATION ORTHOPEDIC PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:REHABILITATION ORTHOPEDIC PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:323-887-7458
Mailing Address - Street 1:PO BOX 45195
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-0191
Mailing Address - Country:US
Mailing Address - Phone:323-887-7458
Mailing Address - Fax:323-887-8288
Practice Address - Street 1:5301 WHITTIER BLVD
Practice Address - Street 2:ATRIUM SUITE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4038
Practice Address - Country:US
Practice Address - Phone:323-887-7458
Practice Address - Fax:323-887-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT116802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty