Basic Information
| Provider Information | |||||||||
| NPI: | 1366977639 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORSTER PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106568600 | ||||||||
| FaxNumber: | 3106568606 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106568600 | ||||||||
| FaxNumber: | 3106568606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2017 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | REED-DUPLESSIS | ||||||||
| AuthorizedOfficialFirstName: | RAINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3106568604 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA48636 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.