Provider Demographics
NPI:1205931482
Name:ADVANCED ORTHOPEDIC PHYSICAL THERAPY
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-595-5159
Mailing Address - Street 1:2501 CHERRY AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2031
Mailing Address - Country:US
Mailing Address - Phone:562-595-5159
Mailing Address - Fax:562-595-7839
Practice Address - Street 1:2501 CHERRY AVE STE 250
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2041
Practice Address - Country:US
Practice Address - Phone:562-595-5159
Practice Address - Fax:562-595-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16190Medicare ID - Type Unspecified