=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184610750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER PHYSICAL THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12620 ERICKSON AVE SUITE B
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90242-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-940-0286
-----------------------------------------------------
Fax | 562-940-0288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12620 ERICKSON AVE SUITE B
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90242-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-940-0286
-----------------------------------------------------
Fax | 562-940-0288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GLENN A. DROBOT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 562-940-0286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT12602
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT22917
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT5926
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------