Provider Demographics
NPI:1982751285
Name:LONG BEACH TOTAL BODY THERAPY INC
Entity Type:Organization
Organization Name:LONG BEACH TOTAL BODY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICAL DIRECTOR,
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:THAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:562-435-4561
Mailing Address - Street 1:295 E 3RD ST
Mailing Address - Street 2:A 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3141
Mailing Address - Country:US
Mailing Address - Phone:562-435-4561
Mailing Address - Fax:
Practice Address - Street 1:295 E 3RD ST
Practice Address - Street 2:A 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3141
Practice Address - Country:US
Practice Address - Phone:562-435-4561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty