Healthcare Provider Details

I. General information

NPI: 1073666327
Provider Name (Legal Business Name): FUNCTIONAL PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SANTA ANITA AVE STE 210
ARCADIA CA
91006-3181
US

IV. Provider business mailing address

150 N SANTA ANITA AVE STE 210
ARCADIA CA
91006-3181
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-3862
  • Fax: 626-446-3860
Mailing address:
  • Phone: 626-446-3862
  • Fax: 626-446-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateCA

VIII. Authorized Official

Name: FRANK CHOW
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: D.P.T.
Phone: 626-446-3862