Provider Demographics
NPI:1043849029
Name:UR THERAPIST
Entity type:Organization
Organization Name:UR THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-339-0450
Mailing Address - Street 1:407 AVENIDA DE JOSE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6611
Mailing Address - Country:US
Mailing Address - Phone:310-497-8324
Mailing Address - Fax:
Practice Address - Street 1:17031 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5883
Practice Address - Country:US
Practice Address - Phone:818-894-8974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy