Healthcare Provider Details

I. General information

NPI: 1497103816
Provider Name (Legal Business Name): JAMES PETER MILNES PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6306 W 77TH PL
LOS ANGELES CA
90045-1410
US

IV. Provider business mailing address

6306 W 77TH PL
LOS ANGELES CA
90045-1410
US

V. Phone/Fax

Practice location:
  • Phone: 323-646-1123
  • Fax:
Mailing address:
  • Phone: 323-646-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42355
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number42355
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number42355
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number42355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: