Provider Demographics
NPI:1952388639
Name:PON PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PON PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-846-3385
Mailing Address - Street 1:1944 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1644
Mailing Address - Country:US
Mailing Address - Phone:818-846-3385
Mailing Address - Fax:818-334-4922
Practice Address - Street 1:1944 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1644
Practice Address - Country:US
Practice Address - Phone:818-846-3385
Practice Address - Fax:818-334-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18593261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA610466700OtherUS DEPT OF LABOR
CAOPT185930OtherBS OF CA
CAOPT185930OtherBS OF CA