Provider Demographics
NPI:1184610750
Name:PREMIER PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:PREMIER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DROBOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-940-0286
Mailing Address - Street 1:12620 ERICKSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4013
Mailing Address - Country:US
Mailing Address - Phone:562-940-0286
Mailing Address - Fax:562-940-0288
Practice Address - Street 1:12620 ERICKSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4013
Practice Address - Country:US
Practice Address - Phone:562-940-0286
Practice Address - Fax:562-940-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12602225100000X
CAPT22917225100000X
CAPT5926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY10985Medicare UPIN