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Organization
PREMIER PHYSICAL THERAPY AND WELLNESS CLINIC INC.
Active
Organization
PREMIER PHYSICAL THERAPY AND WELLNESS CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN ANTHONY BERKOVICH PT (OWNER)
(310) 519-1030
Entity
Organization
Contact information
Practice address
1300 W 6TH ST, SUITE 3, SAN PEDRO, CA 90732-3531
(310) 217-9088
Mailing address
1300 W 6TH ST STE 3, SAN PEDRO, CA 90732-3531
(310) 519-1030
(310) 519-0194
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT26104
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DL193A
MEDICARE PTAN
CA
Enumeration date
03/11/2013
Last updated
03/06/2018
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