Provider Demographics
NPI:1609929256
Name:PACIFIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PACIFIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ARGENTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:310-544-6264
Mailing Address - Street 1:550 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 297
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3664
Mailing Address - Country:US
Mailing Address - Phone:310-544-6264
Mailing Address - Fax:
Practice Address - Street 1:550 DEEP VALLEY DR
Practice Address - Street 2:SUITE 297
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3664
Practice Address - Country:US
Practice Address - Phone:310-544-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16180Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER