Healthcare Provider Details

I. General information

NPI: 1518916246
Provider Name (Legal Business Name): SAN GABRIEL VALLEY PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/04/2023
Certification Date: 02/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MAIN ST STE 210
ALHAMBRA CA
91801-4150
US

IV. Provider business mailing address

1300 E MAIN ST STE 210
ALHAMBRA CA
91801-4150
US

V. Phone/Fax

Practice location:
  • Phone: 626-451-9903
  • Fax: 626-451-9937
Mailing address:
  • Phone: 626-243-3829
  • Fax: 626-451-9937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT KWAN
Title or Position: CEO
Credential: D.P.T.
Phone: 626-243-3829