Provider Demographics
NPI:1639296106
Name:USC PHYSICAL THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:USC PHYSICAL THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:YOGI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHARU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:323-865-1200
Mailing Address - Street 1:1640 MARENGO ST
Mailing Address - Street 2:#102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1036
Mailing Address - Country:US
Mailing Address - Phone:323-865-1200
Mailing Address - Fax:323-865-1258
Practice Address - Street 1:1640 MARENGO ST
Practice Address - Street 2:#102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1036
Practice Address - Country:US
Practice Address - Phone:323-865-1200
Practice Address - Fax:323-865-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1384481OtherCIGNA ASSOCIATION NUMBER
CAZZZ01987ZOtherBLUE SHIELD
CAW15433Medicare ID - Type UnspecifiedGROUP ID