Healthcare Provider Details

I. General information

NPI: 1467647230
Provider Name (Legal Business Name): PCPT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19141 BLOOMFIELD AVE
CERRITOS CA
90703-7104
US

IV. Provider business mailing address

19141 BLOOMFIELD AVE
CERRITOS CA
90703-7104
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-8837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20508
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY LIPTAK
Title or Position: OWNER
Credential:
Phone: 562-924-8837