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General NPI Number Information
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NPI Number | 1194135889
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CONCIERGE SERVICE INC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 704 N. IRENA B
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City | REDONDO BEACH
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State | CA
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Zip | 90277
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Country | US
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Telephone | 661-755-4751
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Fax |
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Provider Business Mailing Address
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Address Line | 704 N IRENA AVE B
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2217
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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 | DOCTOR OF PHYSICAL THERAPY
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Name | DR. MARIAM PASHTOONWAR BUTLER
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Credential | DPT
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Telephone | 661-755-4751
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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 | 34642
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 32976
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License Number State | CA
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