Provider Demographics
NPI:1396054953
Name:WOMEN'S ADVANTAGE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:WOMEN'S ADVANTAGE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:GABELSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MSC, MTC, WCS
Authorized Official - Phone:310-370-1200
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-370-1200
Mailing Address - Fax:310-370-1233
Practice Address - Street 1:20911 EARL ST STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4353
Practice Address - Country:US
Practice Address - Phone:310-370-1200
Practice Address - Fax:310-370-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT206332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID