Healthcare Provider Details

I. General information

NPI: 1437085495
Provider Name (Legal Business Name): JOLLIN LAI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE FL 3
GLENDALE CA
91204-2594
US

IV. Provider business mailing address

PO BOX 333
MONTEREY PARK CA
91754-0333
US

V. Phone/Fax

Practice location:
  • Phone: 818-502-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number304053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: