Healthcare Provider Details

I. General information

NPI: 1215459342
Provider Name (Legal Business Name): JAY ISAAC STEVEN SEMEL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W ADAMS BLVD
LOS ANGELES CA
90007-2664
US

IV. Provider business mailing address

12508 CALIFA ST
VALLEY VILLAGE CA
91607-1007
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-1450
  • Fax: 213-742-1453
Mailing address:
  • Phone: 917-620-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36652
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number028470
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: