Provider Demographics
NPI:1174170450
Name:BEYOND PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:BEYOND PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:P
Authorized Official - Last Name:TON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:714-837-4681
Mailing Address - Street 1:1320 MILLER DR APT 16
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1441
Mailing Address - Country:US
Mailing Address - Phone:714-837-4681
Mailing Address - Fax:
Practice Address - Street 1:2990 S SEPULVEDA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3973
Practice Address - Country:US
Practice Address - Phone:323-207-6809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty