Organization
JADE PHYSICAL THERAPY & WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO LUIS SOUTULLO PT (PRESIDENT)
(626) 566-8332
Entity
Organization
Contact information
Practice address
1575 N LAKE AVE, STE 205, PASADENA, CA 91104-2340
(626) 566-8332
(888) 624-7542
Mailing address
819 WRIGHT AVE, APT 28, PASADENA, CA 91104-4474
(786) 306-0778
(888) 624-7542
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
41255
CA
Other
Enumeration date
06/20/2015
Last updated
08/21/2015
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