Provider Demographics
NPI:1710707211
Name:PURO PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PURO PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:562-879-0031
Mailing Address - Street 1:11457 DONA EVITA DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4254
Mailing Address - Country:US
Mailing Address - Phone:562-879-0031
Mailing Address - Fax:
Practice Address - Street 1:11457 DONA EVITA DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4254
Practice Address - Country:US
Practice Address - Phone:562-879-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty