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General NPI Number Information
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NPI Number | 1861605032
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Entity Type | Organization
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Legal Business Name | PHASE IV
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1544 20TH STREET
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-582-8212
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Fax | 310-582-8842
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Provider Business Mailing Address
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Address Line | 427 WILSHIRE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90401
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Country | US
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Telephone | 310-656-8600
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Fax | 310-656-8606
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ROBERT FRANK FORSTER
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Credential | P.T.
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Telephone | 310-582-8212
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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 | PT 10374
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License Number State | CA
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