Provider Demographics
NPI:1669630166
Name:SONSHINE REHAB & PHYSICAL THERAPY CENTER, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SONSHINE REHAB & PHYSICAL THERAPY CENTER, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:NAKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:213-383-0191
Mailing Address - Street 1:2140 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2207
Mailing Address - Country:US
Mailing Address - Phone:213-383-0191
Mailing Address - Fax:213-383-0190
Practice Address - Street 1:2140 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2207
Practice Address - Country:US
Practice Address - Phone:213-383-0191
Practice Address - Fax:213-383-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty