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General NPI Number Information
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NPI Number | 1316367915
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Entity Type | Organization
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Legal Business Name | PREMIER HOME PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 1300 W 6TH ST SUITE 3
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City | SAN PEDRO
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State | CA
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Zip | 90732-3531
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Country | US
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Telephone | 310-519-1030
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Fax | 310-519-0194
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Provider Business Mailing Address
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Address Line | 3146 CROWNVIEW DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6414
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Country | US
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Telephone | 310-918-0765
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. JOHN ANTHONY BERKOVICH
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Credential |
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Telephone | 310-918-0765
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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 | PT26104
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License Number State | CA
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