1457514382 NPI number — CENTRAL CARE PHYSICAL THERAPY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457514382 NPI number — CENTRAL CARE PHYSICAL THERAPY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL CARE PHYSICAL THERAPY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457514382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91709-0080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-590-7997
Provider Business Mailing Address Fax Number:
909-524-4317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4541 PHILADELPHIA ST.
Provider Second Line Business Practice Location Address:
SUITE C-103
Provider Business Practice Location Address City Name:
CHINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91710-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-590-7997
Provider Business Practice Location Address Fax Number:
909-524-4317
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ABELLON
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
UY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-590-7997

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  PT 26928 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1457514382 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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