Provider Demographics
NPI:1982169595
Name:ORIGIN PHYSICAL THERAPY (CA), INC.
Entity Type:Organization
Organization Name:ORIGIN PHYSICAL THERAPY (CA), INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAMPETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-898-2673
Mailing Address - Street 1:1321 UPLAND DR.
Mailing Address - Street 2:PMB 19899
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043
Mailing Address - Country:US
Mailing Address - Phone:310-479-2323
Mailing Address - Fax:310-479-2329
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5012
Practice Address - Country:US
Practice Address - Phone:310-241-4885
Practice Address - Fax:310-479-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty