Healthcare Provider Details

I. General information

NPI: 1619122819
Provider Name (Legal Business Name): KIMBERLY J. BOZART, PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S LAKE AVE SUITE 201
PASADENA CA
91101-5030
US

IV. Provider business mailing address

PO BOX 61216
PASADENA CA
91116-7216
US

V. Phone/Fax

Practice location:
  • Phone: 310-384-5130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT33078
License Number StateCA

VIII. Authorized Official

Name: MS. KIMBERLY JANEEN BOZART
Title or Position: DIRECTOR
Credential: DPT, ATC, CSCS
Phone: 310-384-5130