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Organization
TAG PHYSICAL THERAPY, INC
Active
Organization
TAG PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELINDA GUNTER GARVEY PT (OWNER)
(310) 426-9570
Entity
Organization
Contact information
Practice address
111 PENN ST, EL SEGUNDO, CA 90245-3908
(310) 426-9570
(310) 426-9572
Mailing address
PO BOX 1767, EL SEGUNDO, CA 90245-6767
(310) 426-9570
(310) 426-9572
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT18015
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ66790Z
BLUE SHIELD GROUP NUMBER
CA
Enumeration date
11/06/2006
Last updated
08/22/2020
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