Healthcare Provider Details

I. General information

NPI: 1316932825
Provider Name (Legal Business Name): COMMUNITY PHYSICAL THERAPY CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S LONG BEACH BLVD
COMPTON CA
90221-4028
US

IV. Provider business mailing address

725 S LONG BEACH BLVD
COMPTON CA
90221-4028
US

V. Phone/Fax

Practice location:
  • Phone: 310-631-8703
  • Fax: 310-763-0400
Mailing address:
  • Phone: 310-631-8703
  • Fax: 310-763-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5788
License Number StateCA

VIII. Authorized Official

Name: MR. JOSEPH JACKSON
Title or Position: ADMINISTRATOR
Credential: PT
Phone: 310-631-8703