Provider Demographics
NPI:1194759159
Name:HARMON PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:HARMON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BUFORD
Authorized Official - Middle Name:KERSHAW
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:III
Authorized Official - Credentials:RPT
Authorized Official - Phone:626-960-2853
Mailing Address - Street 1:1250 S SUNSET AVE
Mailing Address - Street 2:#204
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3961
Mailing Address - Country:US
Mailing Address - Phone:626-960-2853
Mailing Address - Fax:626-856-5512
Practice Address - Street 1:1250 S SUNSET AVE
Practice Address - Street 2:#204
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3961
Practice Address - Country:US
Practice Address - Phone:626-960-2853
Practice Address - Fax:626-856-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5299261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0052990Medicaid
CAW14576Medicare PIN