Provider Demographics
NPI:1730197948
Name:ATP PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:ATP PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:626-403-6545
Mailing Address - Street 1:1942 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4959
Mailing Address - Country:US
Mailing Address - Phone:626-403-6545
Mailing Address - Fax:626-441-7660
Practice Address - Street 1:1942 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030
Practice Address - Country:US
Practice Address - Phone:626-403-6545
Practice Address - Fax:626-441-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-08-09
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
CAW19540OtherGROUP ID FOR ATP PHYSICAL
CAY49683Medicare UPIN