Provider Demographics
NPI:1962834275
Name:EXHALE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:EXHALE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:LISTER
Authorized Official - Last Name:WHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-715-9526
Mailing Address - Street 1:PO BOX 3686
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1686
Mailing Address - Country:US
Mailing Address - Phone:310-896-8763
Mailing Address - Fax:310-697-0754
Practice Address - Street 1:326 S PACIFIC COAST HWY STE 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-896-8763
Practice Address - Fax:310-697-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT33897OtherSTATE LIC