Healthcare Provider Details

I. General information

NPI: 1508933052
Provider Name (Legal Business Name): AGAPE PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 W ROUTE 66 STE C
GLENDORA CA
91740-4160
US

IV. Provider business mailing address

765 W ROUTE 66 STE C
GLENDORA CA
91740-4160
US

V. Phone/Fax

Practice location:
  • Phone: 626-857-4711
  • Fax: 626-857-4712
Mailing address:
  • Phone: 626-857-4711
  • Fax: 626-857-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20032
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19905
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY ATALLA SHAHID
Title or Position: OWNER, VICE PRESIDENT
Credential: P.T.
Phone: 626-429-3521