Provider Demographics
NPI:1902157522
Name:WHOLE HEARTED PEDIATRIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WHOLE HEARTED PEDIATRIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS, PCS
Authorized Official - Phone:562-281-7369
Mailing Address - Street 1:4301 ATLANTIC AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-281-7369
Mailing Address - Fax:562-296-4963
Practice Address - Street 1:4301 ATLANTIC AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-281-7369
Practice Address - Fax:562-296-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty