Basic Information
| Provider Information | |||||||||
| NPI: | 1255580304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | D G THERAPY GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12411 SLAUSON AVE | ||||||||
| Address2: | UNIT H | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626935449 | ||||||||
| FaxNumber: | 5626935469 | ||||||||
| Practice Location | |||||||||
| Address1: | 12411 SLAUSON AVE | ||||||||
| Address2: | UNIT H | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626935449 | ||||||||
| FaxNumber: | 5626935469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2008 | ||||||||
| LastUpdateDate: | 09/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | GUTIERREZ | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDRA | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5626935449 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QP2000X | 20271 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QM1300X | 63648 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.