Provider Demographics
NPI:1659546067
Name:TOTAL PHYSICAL THERAPY INSTITUTE, LLC
Entity Type:Organization
Organization Name:TOTAL PHYSICAL THERAPY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:866-940-8784
Mailing Address - Street 1:3053 RANCHO VISTA BLVD
Mailing Address - Street 2:SUITE H-383
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4823
Mailing Address - Country:US
Mailing Address - Phone:866-940-8784
Mailing Address - Fax:661-902-5192
Practice Address - Street 1:540 W LANCASTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2544
Practice Address - Country:US
Practice Address - Phone:866-940-8784
Practice Address - Fax:661-902-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27812Medicare PIN