Provider Demographics
NPI:1518916246
Name:SAN GABRIEL VALLEY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SAN GABRIEL VALLEY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:626-243-3829
Mailing Address - Street 1:1300 E MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4150
Mailing Address - Country:US
Mailing Address - Phone:626-243-3829
Mailing Address - Fax:626-451-9937
Practice Address - Street 1:1300 E MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4150
Practice Address - Country:US
Practice Address - Phone:626-451-9903
Practice Address - Fax:626-451-9937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN GABRIEL VALLEY PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-09
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19235Medicare ID - Type UnspecifiedMEDICARE GROUP ID