Healthcare Provider Details

I. General information

NPI: 1861121667
Provider Name (Legal Business Name): ANDREAS WAILANI REMIS PT, DPT, CSCS, CSPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST STE 102
LOS ANGELES CA
90033-1061
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-1200
  • Fax:
Mailing address:
  • Phone: 626-457-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38852
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT304230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: