Provider Demographics
NPI:1457514382
Name:CENTRAL CARE PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:CENTRAL CARE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:UY
Authorized Official - Last Name:ABELLON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:909-590-7997
Mailing Address - Street 1:PO BOX 2378
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-0080
Mailing Address - Country:US
Mailing Address - Phone:909-590-7997
Mailing Address - Fax:909-524-4317
Practice Address - Street 1:4541 PHILADELPHIA ST.
Practice Address - Street 2:SUITE C-103
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3530
Practice Address - Country:US
Practice Address - Phone:909-590-7997
Practice Address - Fax:909-524-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26928261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457514382Medicaid