Basic Information
| Provider Information | |||||||||
| NPI: | 1124101142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDEPENDENT PHYSICAL THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235 | ||||||||
| Address2: | |||||||||
| City: | PALOS VERDES ESTATES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902740235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105398800 | ||||||||
| FaxNumber: | 3106985410 | ||||||||
| Practice Location | |||||||||
| Address1: | 559 E CARSON ST STE B | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907452721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105398800 | ||||||||
| FaxNumber: | 3102333231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | CIPOLLA | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3105398800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.