Provider Demographics
NPI:1336178144
Name:CHADAM ASSOCIATES INC, A PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:CHADAM ASSOCIATES INC, A PHYSICAL THERAPY CORPORATION
Other - Org Name:SOUTHCOAST REHABILITATION ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAKII
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:661-327-4685
Mailing Address - Street 1:3801 BUCK OWENS BLVD
Mailing Address - Street 2:#116
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-4958
Mailing Address - Country:US
Mailing Address - Phone:661-327-4685
Mailing Address - Fax:661-327-1959
Practice Address - Street 1:3801 BUCK OWENS BLVD
Practice Address - Street 2:#116
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4958
Practice Address - Country:US
Practice Address - Phone:661-327-4685
Practice Address - Fax:661-327-1959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHADAM ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6008261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19077ZMedicare ID - Type Unspecified