Basic Information
| Provider Information | |||||||||
| NPI: | 1720381635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA REHAB CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3130 W OLYMPIC BLVD | ||||||||
| Address2: | STE 280 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900062484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237323232 | ||||||||
| FaxNumber: | 3238439594 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 W OLYMPIC BLVD | ||||||||
| Address2: | STE 280 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900062484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237323232 | ||||||||
| FaxNumber: | 3238439594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2010 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | DUNCAN | ||||||||
| AuthorizedOfficialMiddleName: | HWAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3237323232 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT21950 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT21950 | 01 | CA | PHYSICAL THERAPIST LICENSE | OTHER |