Provider Demographics
NPI:1902110331
Name:HAND THERAPY CENTER OF THE SOUTH BAY, INC.
Entity Type:Organization
Organization Name:HAND THERAPY CENTER OF THE SOUTH BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:310-371-5151
Mailing Address - Street 1:19000 HAWTHORNE BLVD
Mailing Address - Street 2:#230
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1517
Mailing Address - Country:US
Mailing Address - Phone:310-371-5151
Mailing Address - Fax:
Practice Address - Street 1:19000 HAWTHORNE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1517
Practice Address - Country:US
Practice Address - Phone:310-371-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2742225X00000X, 225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomicsGroup - Multi-Specialty