Provider Demographics
NPI:1871562744
Name:OPTC,INC
Entity type:Organization
Organization Name:OPTC,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:GABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-937-8600
Mailing Address - Street 1:2200 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2757
Mailing Address - Country:US
Mailing Address - Phone:310-937-8600
Mailing Address - Fax:310-937-9769
Practice Address - Street 1:2200 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 218
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2757
Practice Address - Country:US
Practice Address - Phone:310-937-8600
Practice Address - Fax:310-937-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16173Medicare ID - Type Unspecified