Healthcare Provider Details

I. General information

NPI: 1598101065
Provider Name (Legal Business Name): LA MAIN PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S BEVERLY DR SUITE 210
BEVERLY HILLS CA
90212-3833
US

IV. Provider business mailing address

260 S BEVERLY DR SUITE 210
BEVERLY HILLS CA
90212-3833
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-7660
  • Fax: 310-273-7661
Mailing address:
  • Phone: 310-273-7660
  • Fax: 310-273-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT27208
License Number StateCA

VIII. Authorized Official

Name: MR. FABRICE GAUTIER
Title or Position: OWNER
Credential: RPT
Phone: 310-273-7660