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General NPI Number Information
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NPI Number | 1114243904
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Entity Type | Organization
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Legal Business Name | WAKABAYASHI PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 4105 OCEAN VIEW BLVD SUITE A
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City | MONTROSE
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State | CA
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Zip | 91020-1520
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Country | US
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Telephone | 818-792-5143
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Fax |
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Provider Business Mailing Address
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Address Line | 4105 OCEAN VIEW BLVD SUITE A
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City | MONTROSE
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State | CA
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Zip | 91020-1520
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Country | US
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Telephone | 818-792-5143
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY WAKABAYASHI
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Credential | PT
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Telephone | 858-414-6552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 36638
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License Number State | CA
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