Provider Demographics
NPI:1669730800
Name:OPTC A PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:OPTC A PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GABOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-837-9700
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2751
Mailing Address - Country:US
Mailing Address - Phone:310-837-9700
Mailing Address - Fax:
Practice Address - Street 1:2530 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2741
Practice Address - Country:US
Practice Address - Phone:562-426-4598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty