Healthcare Provider Details

I. General information

NPI: 1114988227
Provider Name (Legal Business Name): PHYSICAL EDGE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 N SANTA ANITA AVE
ARCADIA CA
91006-3114
US

IV. Provider business mailing address

253 N SANTA ANITA AVE
ARCADIA CA
91006-3114
US

V. Phone/Fax

Practice location:
  • Phone: 626-294-0070
  • Fax: 626-294-0080
Mailing address:
  • Phone: 626-294-0070
  • Fax: 626-294-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: LORRAINE LIMON-SMITH
Title or Position: CFO/CO-OWNER
Credential:
Phone: 626-294-0070