Healthcare Provider Details

I. General information

NPI: 1831441054
Provider Name (Legal Business Name): TOTAL CARE PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE STE 400
COLTON CA
92324-3928
US

IV. Provider business mailing address

PO BOX 10016
REDLANDS CA
92375-3216
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-3396
  • Fax: 909-883-5473
Mailing address:
  • Phone: 909-370-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number29866
License Number StateCA

VIII. Authorized Official

Name: MYUNGJIN KIM
Title or Position: PT/CEO
Credential: PT., MA
Phone: 909-370-3396