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NPI Code Detail

MEDICARE: BACK2 HEALTH PHYSICAL THERAPY INC

MEDICARE: BACK2 HEALTH PHYSICAL THERAPY INC
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
1208100000XPhysical Medicine & Rehabilitation PhysicianPT32430CA

General Provider Information

NPI Number : 1053419408
Entity Type Code : Organization
Provider Name (Legal Business Name) : BACK2 HEALTH PHYSICAL THERAPY INC
Provider Business Mailing Address
First Line : 1335 N LA BREA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-7526
Country : US
Telephone Number : 310-246-1050
Fax Number :
Provider Business Practice Location Address
First Line : 1335 N LA BREA AVE STE 3
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-7565
Country : US
Telephone Number : 310-246-1050
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : VLADISLAV SHUT
Credential : P.T.
Telephone Number : 310-246-1050
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/21/2025

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Directions to “BACK2 HEALTH PHYSICAL THERAPY INC ” Practice Location

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