Provider Demographics
NPI:1902982952
Name:INDEPENDENT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CIPOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-539-8800
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0235
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:310-698-5410
Practice Address - Street 1:501 DEEP VALLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-7605
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:310-698-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2021-04-14
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
CA056858Medicare Oscar/Certification