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General NPI Number Information
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NPI Number | 1679373252
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Entity Type | Organization
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Legal Business Name | TOTAL POTENTIAL PHYSICAL THERAPY: WELLNESS & REHABILITATION, PC
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 2060 HUNTINGTON DR STE 5
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City | SAN MARINO
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State | CA
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Zip | 91108-2044
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Country | US
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Telephone | 424-254-9273
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Fax |
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Provider Business Mailing Address
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Address Line | 713 W DUARTE RD # G242
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City | ARCADIA
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State | CA
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Zip | 91007-7564
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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 | OWNER
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Name | DR. JOEL KIM
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Credential | PT, DPT, CFMT, CST-T
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Telephone | 424-254-9273
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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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