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General NPI Number Information
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NPI Number | 1033305164
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Entity Type | Organization
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Legal Business Name | LAMONT PHYSICAL THERAPY-.
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 10130 MAIN ST STE., A
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City | LAMONT
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State | CA
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Zip | 93241-1740
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Country | US
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Telephone | 661-845-0600
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Fax | 661-845-0640
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Provider Business Mailing Address
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Address Line | 10130 MAIN ST STE., A
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City | LAMONT
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State | CA
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Zip | 93241-1740
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Country | US
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Telephone | 661-845-0600
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Fax | 661-845-0640
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. MICHAEL SHELTON WHITESIDE
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Credential | PT
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Telephone | 661-845-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | OPT23092
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License Number State | CA
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