Provider Demographics
NPI:1912214032
Name:CORE OBJECTIVES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CORE OBJECTIVES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-374-1614
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-0301
Mailing Address - Country:US
Mailing Address - Phone:310-374-1614
Mailing Address - Fax:310-374-1843
Practice Address - Street 1:1625 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2807
Practice Address - Country:US
Practice Address - Phone:310-374-1614
Practice Address - Fax:310-374-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT264012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty