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General NPI Number Information
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NPI Number | 1386002533
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Entity Type | Organization
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Legal Business Name | AZUSA PHYSICAL THERAPY ASSOCIATES
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 680 E ALOSTA AVE SUITE 212
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City | AZUSA
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State | CA
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Zip | 91702-2705
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Country | US
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Telephone | 714-679-1085
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Fax |
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Provider Business Mailing Address
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Address Line | 13341 GARDEN GROVE BLVD SUITE B
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City | GARDEN GROVE
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State | CA
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Zip | 92843-2255
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Country | US
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Telephone | 714-750-4097
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Fax | 714-750-4616
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Authorized Official
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Title or Position | PRESIDENT
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Name | DERRICK SUEKI
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Credential |
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Telephone | 714-679-1085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 23715
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License Number State | CA
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