Provider Demographics
NPI:1811059934
Name:JAMES GEORGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:JAMES GEORGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-361-9499
Mailing Address - Street 1:10609 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2009
Mailing Address - Country:US
Mailing Address - Phone:818-361-9499
Mailing Address - Fax:818-365-2252
Practice Address - Street 1:10609 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2009
Practice Address - Country:US
Practice Address - Phone:818-361-9499
Practice Address - Fax:818-365-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20711Medicare UPIN