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General NPI Number Information
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NPI Number | 1326600529
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Entity Type | Organization
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Legal Business Name | DECONSTRUCT HEALTH PHYSICAL THERAPY & CONSULTING PC
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 3939 ATLANTIC AVE STE 102
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City | LONG BEACH
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State | CA
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Zip | 90807-3535
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Country | US
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Telephone | 310-893-5786
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Fax |
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Provider Business Mailing Address
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Address Line | 1145 E JAY ST
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City | CARSON
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State | CA
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Zip | 90745-3540
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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 | CEO
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Name | DR. MICHAEL ZABALA AQUINO
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Credential | PT, DPT
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Telephone | 310-508-5648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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