Provider Demographics
NPI:1699050260
Name:PTP, INC
Entity type:Organization
Organization Name:PTP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:706-306-3641
Mailing Address - Street 1:1814 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2929
Mailing Address - Country:US
Mailing Address - Phone:706-306-3641
Mailing Address - Fax:818-861-7348
Practice Address - Street 1:320 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3338
Practice Address - Country:US
Practice Address - Phone:626-289-2268
Practice Address - Fax:626-289-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM991AOtherMEDICARE