| |
1830 W Olympic Blvd, Ste 130, Los Angeles, CA 90006-3734 | |
(213) 383-6860 | |
(213) 383-6421 |
Full Name | |
---|---|
Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 1830 W Olympic Blvd, Los Angeles, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164564688 | NPI | - | NPPES |
GPT000880 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | GPT000880 (California) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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1830 W Olympic Blvd Ste 123, Los Angeles, CA 90006-3734 Ph: (213) 383-6860 | 1830 W Olympic Blvd, Ste 130, Los Angeles, CA 90006-3734 Ph: (213) 383-6860 |