| NPI | 1316932825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH JACKSON Administrator 310-631-8703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT5788) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2010-11-04 |