Provider Demographics
NPI:1831441054
Name:TOTAL CARE PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:TOTAL CARE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYUNGJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MA
Authorized Official - Phone:909-370-3396
Mailing Address - Street 1:PO BOX 10016
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-3216
Mailing Address - Country:US
Mailing Address - Phone:909-370-3396
Mailing Address - Fax:
Practice Address - Street 1:930 S MOUNT VERNON AVE STE 400
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3928
Practice Address - Country:US
Practice Address - Phone:909-370-3396
Practice Address - Fax:909-883-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QX0100X, 261QH0700X
CA29866261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech