Provider Demographics
NPI:1386002533
Name:AZUSA PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:AZUSA PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-679-1085
Mailing Address - Street 1:13341 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2255
Mailing Address - Country:US
Mailing Address - Phone:714-750-4097
Mailing Address - Fax:714-750-4616
Practice Address - Street 1:680 E ALOSTA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2705
Practice Address - Country:US
Practice Address - Phone:714-679-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty