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General NPI Number Information
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NPI Number | 1922773159
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Entity Type | Organization
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Legal Business Name | BRIDGE PHYSICAL THERAPY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 6301 BEACH BLVD STE 102
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City | BUENA PARK
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State | CA
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Zip | 90621-2840
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Country | US
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Telephone | 657-255-4252
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Fax | 657-255-4258
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Provider Business Mailing Address
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Address Line | 6301 BEACH BLVD STE 102
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City | BUENA PARK
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State | CA
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Zip | 90621-2840
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Country | US
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Telephone | 657-255-4252
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Fax | 657-255-4258
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Authorized Official
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Title or Position | PRESEDENT
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Name | SE JIN SON
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Credential | PT
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Telephone | 213-268-7218
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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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