Provider Demographics
NPI:1356367874
Name:INSIGHT PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:INSIGHT PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PLONKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MTOM
Authorized Official - Phone:310-453-8668
Mailing Address - Street 1:2001 S BARRINGTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5337
Mailing Address - Country:US
Mailing Address - Phone:310-453-8668
Mailing Address - Fax:310-453-8662
Practice Address - Street 1:2001 S BARRINGTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5337
Practice Address - Country:US
Practice Address - Phone:310-453-8668
Practice Address - Fax:310-453-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18993Medicare PIN