Healthcare Provider Details

I. General information

NPI: 1790188928
Provider Name (Legal Business Name): RYU PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S VIRGIL AVE STE 201
LOS ANGELES CA
90020-1425
US

IV. Provider business mailing address

520 S VIRGIL AVE STE 201
LOS ANGELES CA
90020-1425
US

V. Phone/Fax

Practice location:
  • Phone: 213-365-0023
  • Fax: 323-978-4342
Mailing address:
  • Phone: 213-365-0023
  • Fax: 323-978-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number41517
License Number StateCA

VIII. Authorized Official

Name: MINSIK RYU
Title or Position: PRESIDENT
Credential: P.T.
Phone: 213-365-0023