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General NPI Number Information
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NPI Number | 1679308852
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Entity Type | Organization
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Legal Business Name | SOCAL KIDS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1945 PALO VERDE AVE STE 204
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City | LONG BEACH
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State | CA
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Zip | 90815-3445
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Country | US
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Telephone | 562-247-3467
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Fax |
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Provider Business Mailing Address
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Address Line | 5869 E PAGEANTRY ST
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City | LONG BEACH
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State | CA
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Zip | 90808-3717
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Country | US
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Telephone | 562-810-3197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROL IANNESSA
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Credential | MPT
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Telephone | 562-810-3197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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