Provider Demographics
NPI:1720626872
Name:SOUTHBAY LOS ANGELES PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:SOUTHBAY LOS ANGELES PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:323-842-0976
Mailing Address - Street 1:146 PASEO DE LA CONCHA APT D
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6239
Mailing Address - Country:US
Mailing Address - Phone:323-842-0976
Mailing Address - Fax:
Practice Address - Street 1:148 MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6386
Practice Address - Country:US
Practice Address - Phone:562-493-8426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty