Healthcare Provider Details

I. General information

NPI: 1417002361
Provider Name (Legal Business Name): LA REHAB & PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 W OLYMPIC BLVD
LOS ANGELES CA
90015-3806
US

IV. Provider business mailing address

1551 W OLYMPIC BLVD
LOS ANGELES CA
90015-3806
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-7478
  • Fax: 213-381-7479
Mailing address:
  • Phone: 213-381-7478
  • Fax: 213-381-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTIAN EUNSUNG CHUNG
Title or Position: OFFICER
Credential: D.C.
Phone: 213-381-7478