Healthcare Provider Details

I. General information

NPI: 1184758161
Provider Name (Legal Business Name): GOOD REHAB PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W OLYMPIC BLVD SUITE 302
LOS ANGELES CA
90006-2699
US

IV. Provider business mailing address

2727 W OLYMPIC BLVD SUITE 302
LOS ANGELES CA
90006-2699
US

V. Phone/Fax

Practice location:
  • Phone: 213-382-0088
  • Fax: 213-380-2038
Mailing address:
  • Phone: 213-382-0088
  • Fax: 213-380-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberW18556
License Number StateCA

VIII. Authorized Official

Name: MRS. MI Y YOU
Title or Position: DIRECTOR
Credential: RPT
Phone: 213-382-0088