Provider Demographics
NPI:1285076265
Name:CPRX, INCORPORATED
Entity type:Organization
Organization Name:CPRX, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MATTESON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CSCS
Authorized Official - Phone:562-799-4494
Mailing Address - Street 1:3662 KATELLA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3124
Mailing Address - Country:US
Mailing Address - Phone:562-799-4494
Mailing Address - Fax:562-280-0304
Practice Address - Street 1:3771 KATELLA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3108
Practice Address - Country:US
Practice Address - Phone:562-799-4494
Practice Address - Fax:562-280-0304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CPRX, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT224342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty