Organization
COMMUNITY PHYSICAL THERAPY CTR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH JACKSON PT (ADMINISTRATOR)
(310) 631-8703
Entity
Organization
Contact information
Practice address
725 S LONG BEACH BLVD, COMPTON, CA 90221-4028
(310) 631-8703
(310) 763-0400
Mailing address
725 S LONG BEACH BLVD, COMPTON, CA 90221-4028
(310) 631-8703
(310) 763-0400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5788
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CW140A
PTAN
CA
Enumeration date
09/12/2005
Last updated
11/04/2010
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