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Organization
ORTHOPAEDIC MEDICAL GROUP & ATHLETIC REHABILITATION CENTER, INC
Active
Organization
ORTHOPAEDIC MEDICAL GROUP & ATHLETIC REHABILITATION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O BRYAN MD (PRESIDENT)
(626) 918-6655
Entity
Organization
Contact information
Practice address
1050 LAKES DR, STE 100, WEST COVINA, CA 91790
(626) 918-6655
(626) 918-6633
Mailing address
1050 LAKES DR STE 100, WEST COVINA, CA 91790-2929
(626) 918-6655
(626) 918-6633
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
NULL
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0048930
—
CA
01
—
GR0048931
MEDICAL
CA
01
—
ZZZ16473Z
BLUE SHIELD OF CA
CA
Enumeration date
12/12/2006
Last updated
08/27/2015
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