Healthcare Provider Details

I. General information

NPI: 1215771381
Provider Name (Legal Business Name): ANGLE PHYSICAL THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E VALLEY BLVD STE 206
SAN GABRIEL CA
91776-4702
US

IV. Provider business mailing address

123 E VALLEY BLVD STE 206
SAN GABRIEL CA
91776-4702
US

V. Phone/Fax

Practice location:
  • Phone: 626-297-8998
  • Fax: 626-254-1588
Mailing address:
  • Phone: 626-297-8998
  • Fax: 626-254-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHE-CHERNG LEE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 626-688-1762