Provider Demographics
NPI:1184811861
Name:THE CENTER FOR PHYSICAL HEALTH MOVEMENT FORWARD INC.
Entity type:Organization
Organization Name:THE CENTER FOR PHYSICAL HEALTH MOVEMENT FORWARD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-475-6038
Mailing Address - Street 1:10780 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4749
Mailing Address - Country:US
Mailing Address - Phone:310-475-6038
Mailing Address - Fax:310-441-5367
Practice Address - Street 1:10780 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4749
Practice Address - Country:US
Practice Address - Phone:310-475-6038
Practice Address - Fax:310-441-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15054Medicare PIN