Provider Demographics
NPI:1629325055
Name:WELL CARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WELL CARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:POH-SANG
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:626-965-2229
Mailing Address - Street 1:1661 HANOVER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1734
Mailing Address - Country:US
Mailing Address - Phone:626-965-2229
Mailing Address - Fax:626-408-6618
Practice Address - Street 1:1661 HANOVER RD STE 104
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1734
Practice Address - Country:US
Practice Address - Phone:626-965-2229
Practice Address - Fax:626-408-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty