Provider Demographics
NPI:1518010610
Name:JC PRACTICE DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:JC PRACTICE DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:GODOY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:562-453-7236
Mailing Address - Street 1:5201 LINCOLN AVE
Mailing Address - Street 2:UNIT 219
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2913
Mailing Address - Country:US
Mailing Address - Phone:562-453-7236
Mailing Address - Fax:714-995-4985
Practice Address - Street 1:5201 LINCOLN AVE
Practice Address - Street 2:UNIT 219
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2913
Practice Address - Country:US
Practice Address - Phone:562-453-7236
Practice Address - Fax:714-995-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN