Provider Demographics
NPI:1902079452
Name:ABLE PHYSICAL THERAPY CORP
Entity Type:Organization
Organization Name:ABLE PHYSICAL THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:909-620-9700
Mailing Address - Street 1:101 W MISSION BLVD
Mailing Address - Street 2:SUITE 110-397
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1711
Mailing Address - Country:US
Mailing Address - Phone:909-620-9700
Mailing Address - Fax:909-620-9800
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:STE 170
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-620-9700
Practice Address - Fax:909-620-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22634Medicare PIN