Provider Demographics
NPI:1679373252
Name:TOTAL POTENTIAL PHYSICAL THERAPY: WELLNESS & REHABILITATION, PC
Entity type:Organization
Organization Name:TOTAL POTENTIAL PHYSICAL THERAPY: WELLNESS & REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CFMT, CST-T
Authorized Official - Phone:424-254-9273
Mailing Address - Street 1:713 W DUARTE RD # G242
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2060 HUNTINGTON DR STE 5
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2044
Practice Address - Country:US
Practice Address - Phone:424-254-9273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy