Healthcare Provider Details

I. General information

NPI: 1821675547
Provider Name (Legal Business Name): VMAX PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 COLORADO BLVD STE 130
LOS ANGELES CA
90041-2373
US

IV. Provider business mailing address

1480 COLORADO BLVD STE 130
LOS ANGELES CA
90041-2373
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-3151
  • Fax:
Mailing address:
  • Phone: 401-447-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HERMINE DOLARIAN
Title or Position: CEO
Credential: MSPT
Phone: 401-447-3151