Healthcare Provider Details

I. General information

NPI: 1598029159
Provider Name (Legal Business Name): INCOURAGE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2693 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

IV. Provider business mailing address

582 ELDORA RD
PASADENA CA
91104-3613
US

V. Phone/Fax

Practice location:
  • Phone: 626-722-8032
  • Fax: 626-722-5100
Mailing address:
  • Phone: 213-924-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT27434
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT27434
License Number StateCA

VIII. Authorized Official

Name: NDIDIAMAKA DILLIBE MATTHEWS
Title or Position: OWNER
Credential: DPT
Phone: 213-924-4377