Healthcare Provider Details

I. General information

NPI: 1073845376
Provider Name (Legal Business Name): ANGEL PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W HOLT AVE
POMONA CA
91768-3604
US

IV. Provider business mailing address

502 W HOLT AVE
POMONA CA
91768-3604
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-5699
  • Fax:
Mailing address:
  • Phone: 909-620-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RASOUL POOYANDEH
Title or Position: CEO
Credential:
Phone: 909-620-5699