Provider Demographics
NPI:1528586468
Name:INFINITY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:INFINITY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMAD LIBIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:714-620-8980
Mailing Address - Street 1:12800 GARDEN GROVE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2008
Mailing Address - Country:US
Mailing Address - Phone:714-620-8980
Mailing Address - Fax:714-620-8982
Practice Address - Street 1:12800 GARDEN GROVE BLVD STE F
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2008
Practice Address - Country:US
Practice Address - Phone:714-620-8980
Practice Address - Fax:714-620-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871748822OtherNPI