Basic Information
| Provider Information | |||||||||
| NPI: | 1437290780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHINATOWN PHYSICAL THERAPY & REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 728 PACIFIC AVE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941334457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154333318 | ||||||||
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| Practice Location | |||||||||
| Address1: | 728 PACIFIC AVE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941334457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154333318 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 06/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHUNG YEUNG | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 4154333318 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | D.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14973 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT0149730 | 01 | CA | MEDI-CAL PROVIDER NUMBER | OTHER | 14973 | 01 | CA | PT BOARD OF CA LICENSE | OTHER |