Provider Demographics
NPI:1952827198
Name:PRO PERFORMANCE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PRO PERFORMANCE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:909-576-4389
Mailing Address - Street 1:2740 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3806
Mailing Address - Country:US
Mailing Address - Phone:310-351-1464
Mailing Address - Fax:424-256-2300
Practice Address - Street 1:2738 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3806
Practice Address - Country:US
Practice Address - Phone:909-576-4389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty