Provider Demographics
NPI:1316932825
Name:COMMUNITY PHYSICAL THERAPY CTR INC
Entity type:Organization
Organization Name:COMMUNITY PHYSICAL THERAPY CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-631-8703
Mailing Address - Street 1:725 S LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-4028
Mailing Address - Country:US
Mailing Address - Phone:310-631-8703
Mailing Address - Fax:310-763-0400
Practice Address - Street 1:725 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-4028
Practice Address - Country:US
Practice Address - Phone:310-631-8703
Practice Address - Fax:310-763-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACW140AOtherPTAN
CAWPT5788AMedicare ID - Type Unspecified