Provider Demographics
NPI:1619122819
Name:KIMBERLY J. BOZART, PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KIMBERLY J. BOZART, PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Other - Org Name:ACCELERATED SPORTS MEDICINE & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JANEEN
Authorized Official - Last Name:BOZART
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, CSCS
Authorized Official - Phone:310-384-5130
Mailing Address - Street 1:PO BOX 61216
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-7216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:345 S LAKE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5030
Practice Address - Country:US
Practice Address - Phone:310-384-5130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33078261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy