Healthcare Provider Details

I. General information

NPI: 1053561373
Provider Name (Legal Business Name): CALIFORNIA PHYSICAL THERAPY MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W REDONDO BEACH BLVD STE 130
GARDENA CA
90247-4129
US

IV. Provider business mailing address

1045 W REDONDO BEACH BLVD STE 130
GARDENA CA
90247-4129
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-1444
  • Fax: 310-329-9586
Mailing address:
  • Phone: 310-329-1444
  • Fax: 310-329-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. JANA VAN SURKSUM
Title or Position: DIRECTOR
Credential: P.T.
Phone: 310-329-1444