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NPI Code Detail

MEDICARE: SHELBY PLUMMER PT, DPT

MEDICARE: SHELBY PLUMMER PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist293445CA

General Provider Information

NPI Number : 1043735079
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY PLUMMER PT, DPT
Provider Business Mailing Address
First Line : 11775 S LA CIENEGA BLVD APT 2338
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-6298
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 615 N NASH ST STE 306
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-2850
Country : US
Telephone Number : 310-535-0008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 08/10/2017

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Directions to “ SHELBY PLUMMER PT, DPT” Practice Location

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