MEDICARE: PHYSIOFLOW

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1689563637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOFLOW

Provider Business Mailing Address
First Line	:	1503 LAKE SHORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 LAKE SHORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2531
Country	:	US
Telephone Number	:	415-819-7866
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MELISSA WONG
Credential	:	DPT
Telephone Number	:	415-819-7866

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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Directions to “PHYSIOFLOW ” Practice Location

Language	Start Address	Practice Location

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