Healthcare Provider Details

I. General information

NPI: 1396042420
Provider Name (Legal Business Name): SHREYA TAILOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 CENTER DR FL 10
LOS ANGELES CA
90045-1598
US

IV. Provider business mailing address

PO BOX 1295
VENICE CA
90294-1295
US

V. Phone/Fax

Practice location:
  • Phone: 888-859-0145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT010154
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT010154
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT010154
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: