Provider Demographics
NPI:1639569312
Name:CJ PHYSIOTHERAPY INC
Entity Type:Organization
Organization Name:CJ PHYSIOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KYONG
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:714-832-6780
Mailing Address - Street 1:1051 BRYAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4419
Mailing Address - Country:US
Mailing Address - Phone:714-832-6780
Mailing Address - Fax:
Practice Address - Street 1:1051 BRYAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4419
Practice Address - Country:US
Practice Address - Phone:714-832-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32102225100000X
CA26577225100000X
CA5641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty