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General NPI Number Information
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NPI Number | 1861565806
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Entity Type | Organization
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Legal Business Name | SOUTH COAST PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 5750 DOWNEY AVE #301
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City | LAKEWOOD
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State | CA
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Zip | 90712
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Country | US
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Telephone | 562-633-3501
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Fax | 562-633-6178
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Provider Business Mailing Address
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Address Line | 17752 BEACH BLVD #306
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646
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Country | US
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Telephone | 714-842-6171
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Fax | 714-842-0281
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OFFICE MANAGER
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Name | SOAD A SALAM
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Credential | RPT
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Telephone | 714-842-6171
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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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