Healthcare Provider Details

I. General information

NPI: 1184076267
Provider Name (Legal Business Name): PLAY PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 PARK PL
EL SEGUNDO CA
90245-4908
US

IV. Provider business mailing address

2711 N SEPULVEDA BLVD #293
MANHATTAN BEACH CA
90266-2725
US

V. Phone/Fax

Practice location:
  • Phone: 310-643-3400
  • Fax: 310-356-3423
Mailing address:
  • Phone: 310-643-3400
  • Fax: 310-356-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT14137
License Number StateCA

VIII. Authorized Official

Name: DAVID W HALBERG
Title or Position: PRESIDENT
Credential: PT
Phone: 310-643-3400