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General NPI Number Information
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NPI Number | 1881247187
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Entity Type | Organization
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Legal Business Name | BALANCE AND MOTION PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 11817 SOUTH STREET
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City | CERRITOS
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State | CA
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Zip | 90703-6825
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Country | US
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Telephone | 562-403-1750
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Fax | 562-403-1743
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Provider Business Mailing Address
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Address Line | 11817 SOUTH STREET
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City | CERRITOS
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State | CA
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Zip | 90703-6825
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Country | US
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Telephone | 562-403-1750
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Fax | 562-403-1743
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. LEONARD RALPH BAUTISTA
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Credential | MPT
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Telephone | 562-320-9242
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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 |
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License Number State |
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