MEDICARE: TOTAL POTENTIAL PHYSICAL THERAPY: WELLNESS & REHABILITATION, PC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1679373252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL POTENTIAL PHYSICAL THERAPY: WELLNESS & REHABILITATION, PC

Provider Business Mailing Address
First Line	:	713 W DUARTE RD # G242
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-7564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 HUNTINGTON DR STE 5
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2044
Country	:	US
Telephone Number	:	424-254-9273
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOEL KIM
Credential	:	PT, DPT, CFMT, CST-T
Telephone Number	:	424-254-9273

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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