Provider Demographics
NPI:1497725832
Name:POGSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:POGSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:V
Authorized Official - Last Name:POGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, COS, FAAOMPT
Authorized Official - Phone:310-392-8259
Mailing Address - Street 1:7611 DUNFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1342
Mailing Address - Country:US
Mailing Address - Phone:310-392-8259
Mailing Address - Fax:310-392-8274
Practice Address - Street 1:2664 29TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2916
Practice Address - Country:US
Practice Address - Phone:310-392-8259
Practice Address - Fax:310-392-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAXPAYER ID #