Healthcare Provider Details

I. General information

NPI: 1699834440
Provider Name (Legal Business Name): EMILY FINE PHYSICAL THERAPY ASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E BEVERLY WAY UNIT 210
LONG BEACH CA
90802-2068
US

IV. Provider business mailing address

1919 E BEVERLY WAY UNIT 210
LONG BEACH CA
90802-2068
US

V. Phone/Fax

Practice location:
  • Phone: 562-901-9194
  • Fax:
Mailing address:
  • Phone: 562-901-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberAT-5389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: