Healthcare Provider Details

I. General information

NPI: 1215396627
Provider Name (Legal Business Name): PHYSICAL THERAPY FITNESS TEAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 E 7TH ST
LONG BEACH CA
90804-5138
US

IV. Provider business mailing address

3535 E 7TH ST
LONG BEACH CA
90804-5138
US

V. Phone/Fax

Practice location:
  • Phone: 562-434-0062
  • Fax: 562-439-4617
Mailing address:
  • Phone: 562-434-0062
  • Fax: 562-439-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT8264
License Number StateCA

VIII. Authorized Official

Name: DR. JESSE MANUEL VALENCIA
Title or Position: PRESIDENT
Credential: DC, PT
Phone: 562-434-0062