Healthcare Provider Details

I. General information

NPI: 1326600529
Provider Name (Legal Business Name): DECONSTRUCT HEALTH PHYSICAL THERAPY & CONSULTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 ATLANTIC AVE STE 102
LONG BEACH CA
90807-3535
US

IV. Provider business mailing address

1145 E JAY ST
CARSON CA
90745-3540
US

V. Phone/Fax

Practice location:
  • Phone: 310-893-5786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ZABALA AQUINO
Title or Position: CEO
Credential: PT, DPT
Phone: 310-508-5648