Provider Demographics
NPI:1528608825
Name:PLEASANT POINT PT, CORP.
Entity type:Organization
Organization Name:PLEASANT POINT PT, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERDMAN-WATERHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-419-4103
Mailing Address - Street 1:100 W BROADWAY STE 750
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91210-1215
Mailing Address - Country:US
Mailing Address - Phone:323-419-4103
Mailing Address - Fax:323-419-5507
Practice Address - Street 1:100 W BROADWAY STE 750
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91210-1215
Practice Address - Country:US
Practice Address - Phone:323-419-4103
Practice Address - Fax:323-419-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265072904OtherPHYSICAL THERAPY AGENCY