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General NPI Number Information
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NPI Number | 1598029159
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Entity Type | Organization
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Legal Business Name | INCOURAGE PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 2693 E WASHINGTON BLVD
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City | PASADENA
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State | CA
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Zip | 91107-1412
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Country | US
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Telephone | 626-722-8032
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Fax | 626-722-5100
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Provider Business Mailing Address
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Address Line | 582 ELDORA RD
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City | PASADENA
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State | CA
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Zip | 91104-3613
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Country | US
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Telephone | 213-924-4377
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NDIDIAMAKA DILLIBE MATTHEWS
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Credential | DPT
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Telephone | 213-924-4377
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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 | PT27434
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT27434
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License Number State | CA
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