Provider Demographics
NPI:1821177767
Name:PRO CARE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PRO CARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOHARATOS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA CFT
Authorized Official - Phone:562-924-8837
Mailing Address - Street 1:19141 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7104
Mailing Address - Country:US
Mailing Address - Phone:562-924-8837
Mailing Address - Fax:
Practice Address - Street 1:19141 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7104
Practice Address - Country:US
Practice Address - Phone:562-924-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP04182Medicare UPIN
CAW15962Medicare ID - Type Unspecified