Provider Demographics
NPI:1790002194
Name:WESTERN PHYSICAL THERAPY MEDICAL GROUP
Entity Type:Organization
Organization Name:WESTERN PHYSICAL THERAPY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:310-782-3333
Mailing Address - Street 1:21081 S WESTERN AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1703
Mailing Address - Country:US
Mailing Address - Phone:310-782-3330
Mailing Address - Fax:
Practice Address - Street 1:21081 S WESTERN AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1703
Practice Address - Country:US
Practice Address - Phone:310-782-3330
Practice Address - Fax:310-212-3461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty