Healthcare Provider Details

I. General information

NPI: 1174679211
Provider Name (Legal Business Name): THERAPEUTIC ADVANTAGE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19191 S VERMONT AVE SUITE 410
TORRANCE CA
90502-1018
US

IV. Provider business mailing address

19191 S VERMONT AVE SUITE 410
TORRANCE CA
90502-1018
US

V. Phone/Fax

Practice location:
  • Phone: 310-327-9101
  • Fax: 310-327-6611
Mailing address:
  • Phone: 310-327-9101
  • Fax: 310-327-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number26393
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6118
License Number StateCA

VIII. Authorized Official

Name: GRACE IMPERIAL HOFFMAN
Title or Position: CEO
Credential: OTRL
Phone: 310-327-9101