Provider Demographics
NPI:1609589761
Name:COSMOS PHYSICAL THERAPY & WELLNESS CORPORATION
Entity Type:Organization
Organization Name:COSMOS PHYSICAL THERAPY & WELLNESS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-334-9998
Mailing Address - Street 1:PO BOX 6609
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6609
Mailing Address - Country:US
Mailing Address - Phone:714-334-9998
Mailing Address - Fax:
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE A120
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4983
Practice Address - Country:US
Practice Address - Phone:714-334-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty