Healthcare Provider Details

I. General information

NPI: 1326057761
Provider Name (Legal Business Name): MARTIN LEWIS WEXLER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 DE SOTO AVE
CHATSWORTH CA
91311-4409
US

IV. Provider business mailing address

18641 TARZANA DR
TARZANA CA
91356-4512
US

V. Phone/Fax

Practice location:
  • Phone: 818-882-8100
  • Fax:
Mailing address:
  • Phone: 818-776-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: