Healthcare Provider Details

I. General information

NPI: 1699171090
Provider Name (Legal Business Name): LINDSAY ANN PIETRUSZEWSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERAN AVE
LOS ANGELES CA
90024-2704
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT41600
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT41600
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number41600
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT41600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: