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General NPI Number Information
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NPI Number | 1669099065
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Entity Type | Organization
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Legal Business Name | THERA READY, LLC
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 7400 CENTER AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647
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Country | US
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Telephone | 540-931-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 815 N LA BREA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-2205
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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 | DIRECTOR OF OPERATIONS
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Name | LANITA MACK
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Credential |
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Telephone | 310-916-9423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 225X00000X
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Taxonomy Name | Occupational 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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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