Provider Demographics
NPI:1407458631
Name:IM PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:IM PHYSICAL THERAPY INC
Other - Org Name:FUNCTIONAL PHYSICAL THERAPY AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SONGCHAN
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:626-449-9910
Mailing Address - Street 1:2245 E COLORADO BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6815
Mailing Address - Country:US
Mailing Address - Phone:626-449-9910
Mailing Address - Fax:626-449-9382
Practice Address - Street 1:2245 E COLORADO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6815
Practice Address - Country:US
Practice Address - Phone:626-449-9910
Practice Address - Fax:626-449-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty