Organization
REVITALIZE REHAB CLUB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANH NGO PT DPT OCS SCS (OWNER, PHYSICAL THERAPIST)
(562) 548-0876
Entity
Organization
Contact information
Practice address
3646 LONG BEACH BLVD STE 106, LONG BEACH, CA 90807-6025
(562) 548-0876
Mailing address
3646 LONG BEACH BLVD STE 106, LONG BEACH, CA 90807-6025
(562) 548-0876
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
30340
CA
2251X0800X
Orthopedic Physical Therapist
Primary
30340
CA
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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