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General NPI Number Information
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NPI Number | 1467632331
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CONNECTION, INC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 87 FRASER ALLEY
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City | PASADENA
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State | CA
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Zip | 91105-3829
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Country | US
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Telephone | 310-490-6435
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Fax |
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Provider Business Mailing Address
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Address Line | 87 FRASER ALLEY
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City | PASADENA
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State | CA
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Zip | 91105-3829
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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 | PRESIDENT
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Name | ELIZABETH RICARDO
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Credential | MSPT
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Telephone | 310-490-6435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT33560
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License Number State | CA
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