Healthcare Provider Details

I. General information

NPI: 1003825019
Provider Name (Legal Business Name): THOMAS JAMES CIPOLLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 CRENSHAW BLVD STE 130
TORRANCE CA
90501-3329
US

IV. Provider business mailing address

PO BOX 235
PALOS VERDES ESTATES CA
90274-0235
US

V. Phone/Fax

Practice location:
  • Phone: 310-539-8800
  • Fax: 424-203-8389
Mailing address:
  • Phone: 310-539-8800
  • Fax: 424-203-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 6837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: