Provider Demographics
NPI:1205935723
Name:PRO-HEALTH PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:PRO-HEALTH PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEKSICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-371-4774
Mailing Address - Street 1:2850 ARTESIA BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3419
Mailing Address - Country:US
Mailing Address - Phone:310-371-4774
Mailing Address - Fax:310-371-3453
Practice Address - Street 1:2850 ARTESIA BLVD
Practice Address - Street 2:STE 207
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3419
Practice Address - Country:US
Practice Address - Phone:310-371-4774
Practice Address - Fax:310-371-3453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16610 CAMedicare PIN
CAW16610Medicare PIN