Provider Demographics
NPI:1003779539
Name:SUNRISE PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:SUNRISE PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MARISCAL VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:323-395-1412
Mailing Address - Street 1:2550 KURT AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2312
Mailing Address - Country:US
Mailing Address - Phone:323-395-1412
Mailing Address - Fax:
Practice Address - Street 1:2550 KURT AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2312
Practice Address - Country:US
Practice Address - Phone:323-395-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty