Bridge Physical Therapy Professional Corporation

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BRIDGE PHYSICAL THERAPY PROFESSIONAL CORPORATION

Practice address

6301 Beach Blvd Ste 102
Buena Park, CA 90621-2840

Phone

(657) 255-4252

Fax

(657) 255-4258

NPI assigned

Aug 10, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

SE Jin Son, PT

Title

Presedent

Phone

(213) 268-7218

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1922773159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 BEACH BLVD STE 102",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906212840",
            "telephone_number": "657-255-4252",
            "fax_number": "657-255-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 BEACH BLVD STE 102",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906212840",
            "telephone_number": "657-255-4252",
            "fax_number": "657-255-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE PHYSICAL THERAPY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "SON",
        "authorized_official_first_name": "SE JIN",
        "authorized_official_title_or_position": "PRESEDENT",
        "authorized_official_telephone_number": "213-268-7218",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Buena Park, CA
• Providers in Buena Park, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.