MEDICARE: LB 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
1	225100000X	Physical Therapist	PT20435	CA

General Provider Information

NPI Number	:	1245430479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LB PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	1191 N VERMONT AVE
Second Line	:	UNIT C
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1701
Country	:	US
Telephone Number	:	323-668-5535
Fax Number	:	323-668-0666

Provider Business Practice Location Address
First Line	:	1201 LARRABEE ST
Second Line	:	208
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-2033
Country	:	US
Telephone Number	:	310-652-8888
Fax Number	:	323-668-0666

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LEONID BRENNER
Credential	:	P.T.
Telephone Number	:	323-668-5535

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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