Healthcare Provider Details

I. General information

NPI: 1922376607
Provider Name (Legal Business Name): SCOTT FREEDMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 BALBOA BLVD SUITE 202
ENCINO CA
91316-2804
US

IV. Provider business mailing address

5353 BALBOA BLVD SUITE 202
ENCINO CA
91316-2804
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number26733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: