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General NPI Number Information
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NPI Number | 1215396627
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY FITNESS TEAM, INC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 3535 E 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90804-5138
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Country | US
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Telephone | 562-434-0062
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Fax | 562-439-4617
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Provider Business Mailing Address
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Address Line | 3535 E 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90804-5138
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Country | US
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Telephone | 562-434-0062
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Fax | 562-439-4617
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSE MANUEL VALENCIA
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Credential | DC, PT
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Telephone | 562-434-0062
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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 | PT8264
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License Number State | CA
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