Provider Demographics
NPI:1922979319
Name:RETHERFORD PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:RETHERFORD PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:RETHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:510-214-3645
Mailing Address - Street 1:9632 LUCERNE AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4700 W JEFFERSON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4055
Practice Address - Country:US
Practice Address - Phone:510-214-3645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy