Healthcare Provider Details

I. General information

NPI: 1912779877
Provider Name (Legal Business Name): JOANA AMEZCUA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17042 BELLFLOWER BLVD STE 201
BELLFLOWER CA
90706-5950
US

IV. Provider business mailing address

817 W BEVERLY BLVD STE 201
MONTEBELLO CA
90640-4265
US

V. Phone/Fax

Practice location:
  • Phone: 562-991-1324
  • Fax: 562-502-9862
Mailing address:
  • Phone: 562-991-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT304958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: