1225009871 NPI number — VINCENT PHYSICAL THERAPY CORPORATION

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 1225009871 NPI number — VINCENT PHYSICAL THERAPY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT PHYSICAL THERAPY CORPORATION
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:
1225009871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 E FOOTHILL BLVD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91107-3443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-449-4347
Provider Business Mailing Address Fax Number:
626-449-4317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 E FOOTHILL BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91107-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-449-4347
Provider Business Practice Location Address Fax Number:
626-449-4317
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
MICHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, PRESIDENT
Authorized Official Telephone Number:
626-449-4347

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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: ZZZ03532Z . This is a "BLUE SHIELD GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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