Healthcare Provider Details

I. General information

NPI: 1790360626
Provider Name (Legal Business Name): ABRAHAM ESCOBAR PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E OLIVE AVE
MONROVIA CA
91016-3407
US

IV. Provider business mailing address

410 RAYMONDALE DR APT 1
SOUTH PASADENA CA
91030-2139
US

V. Phone/Fax

Practice location:
  • Phone: 626-531-0787
  • Fax:
Mailing address:
  • Phone: 323-447-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: