Provider Demographics
NPI:1184725699
Name:PROFESSIONAL PHYSICAL THERAPY ASSOCIATES, INC.
Entity type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:CAZARES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:562-945-1587
Mailing Address - Street 1:15141 WHITTIER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2135
Mailing Address - Country:US
Mailing Address - Phone:562-945-1587
Mailing Address - Fax:562-696-9687
Practice Address - Street 1:15141 WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2135
Practice Address - Country:US
Practice Address - Phone:562-945-1587
Practice Address - Fax:562-696-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15690Medicare UPIN