Organization
PREMIER HOME PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN ANTHONY BERKOVICH (PHYSICAL THERAPIST)
(310) 918-0765
Entity
Organization
Contact information
Practice address
1300 W 6TH ST, SUITE 3, SAN PEDRO, CA 90732-3531
(310) 519-1030
(310) 519-0194
Mailing address
3146 CROWNVIEW DR, RANCHO PALOS VERDES, CA 90275-6414
(310) 918-0765
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT26104
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT26104
MEDICARE PTAN
CA
Enumeration date
04/22/2014
Last updated
04/22/2014
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