Provider Demographics
NPI:1831977230
Name:CYPRESS PHYSICAL THERAPY CENTER, INC.
Entity type:Organization
Organization Name:CYPRESS PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-589-9909
Mailing Address - Street 1:6014 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3001
Mailing Address - Country:US
Mailing Address - Phone:801-589-9909
Mailing Address - Fax:
Practice Address - Street 1:860 VIA DE LA PAZ STE B1
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3681
Practice Address - Country:US
Practice Address - Phone:310-573-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty