Provider Demographics
NPI:1184765349
Name:WESTERN PHYSICAL THERAPY
Entity type:Organization
Organization Name:WESTERN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:562-928-0121
Mailing Address - Street 1:9901 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9901 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3843
Practice Address - Country:US
Practice Address - Phone:562-928-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15093Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #