Healthcare Provider Details

I. General information

NPI: 1669099065
Provider Name (Legal Business Name): THERA READY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 CENTER AVE
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

815 N LA BREA AVE
INGLEWOOD CA
90302-2205
US

V. Phone/Fax

Practice location:
  • Phone: 540-931-9150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LANITA MACK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 310-916-9423