MEDICARE: COMMUNITY PHYSICAL THERAPY CTR INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT5788	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW140A	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1316932825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PHYSICAL THERAPY CTR INC

Provider Business Mailing Address
First Line	:	725 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-4028
Country	:	US
Telephone Number	:	310-631-8703
Fax Number	:	310-763-0400

Provider Business Practice Location Address
First Line	:	725 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-4028
Country	:	US
Telephone Number	:	310-631-8703
Fax Number	:	310-763-0400

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOSEPH JACKSON
Credential	:	PT
Telephone Number	:	310-631-8703

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	11/04/2010

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