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General NPI Number Information
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NPI Number | 1063083723
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL REHABILITATION PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 3300 E SOUTH ST STE 203
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City | LAKEWOOD
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State | CA
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Zip | 90805-4589
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Country | US
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Telephone | 562-303-6366
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Fax | 562-381-7764
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Provider Business Mailing Address
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Address Line | 3300 E SOUTH ST STE 203
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City | LAKEWOOD
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State | CA
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Zip | 90805-4589
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CARLOS PENA PINEDA III
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Credential | DPT
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Telephone | 562-303-6366
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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 |
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License Number State |
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