Provider Demographics
NPI:1578980330
Name:THE PHYSICAL EDGE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:THE PHYSICAL EDGE PHYSICAL THERAPY INC
Other - Org Name:THE PHYSICAL EDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:F
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-294-0070
Mailing Address - Street 1:253 N SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3114
Mailing Address - Country:US
Mailing Address - Phone:626-294-0070
Mailing Address - Fax:626-294-0080
Practice Address - Street 1:253 N SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3114
Practice Address - Country:US
Practice Address - Phone:626-294-0070
Practice Address - Fax:626-294-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty