Healthcare Provider Details

I. General information

NPI: 1851776694
Provider Name (Legal Business Name): RELIABLE EMG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 SAWTELLE BLVD APT 140
LOS ANGELES CA
90066-2163
US

IV. Provider business mailing address

3450 SAWTELLE BLVD APT 140
LOS ANGELES CA
90066-2163
US

V. Phone/Fax

Practice location:
  • Phone: 970-691-3504
  • Fax:
Mailing address:
  • Phone: 970-691-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number43805
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number37416
License Number StateCA

VIII. Authorized Official

Name: SCOTT MCCAULEY
Title or Position: PROVIDER
Credential: DPT, ECS, OCS
Phone: 970-691-3504