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General NPI Number Information
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NPI Number | 1922979319
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Entity Type | Organization
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Legal Business Name | RETHERFORD PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 4700 W JEFFERSON BLVD STE 107
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City | LOS ANGELES
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State | CA
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Zip | 90016-4055
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Country | US
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Telephone | 510-214-3645
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Fax |
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Provider Business Mailing Address
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Address Line | 9632 LUCERNE AVE APT 14
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City | CULVER CITY
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State | CA
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Zip | 90232-2939
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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 | KELTON RETHERFORD
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Credential | DPT
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Telephone | 510-214-3645
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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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