MEDICARE: VLADISLAV SHUT D.P.T.

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	208100000X	Physical Medicine & Rehabilitation Physician	PT32430	CA
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205559183	OTHER	CA	TAX ID
2	PT32430	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1578501052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VLADISLAV SHUT D.P.T.

Provider Business Mailing 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	:

Provider Business Practice Location 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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	11/21/2025

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