Provider Demographics
NPI:1689844300
Name:HARA/NELSON PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:HARA/NELSON PHYSICAL THERAPY CORPORATION
Other - Org Name:HARA/NELSON PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-481-9965
Mailing Address - Street 1:11687 NATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3801
Mailing Address - Country:US
Mailing Address - Phone:310-481-9965
Mailing Address - Fax:310-481-9986
Practice Address - Street 1:11687 NATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3801
Practice Address - Country:US
Practice Address - Phone:310-481-9965
Practice Address - Fax:310-481-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-10-30
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