Healthcare Provider Details

I. General information

NPI: 1720335797
Provider Name (Legal Business Name): JASON WHITMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5478 WILSHIRE BLVD STE 208
LOS ANGELES CA
90036-4225
US

IV. Provider business mailing address

12207 SANTA MONICA BLVD
LOS ANGELES CA
90025-2517
US

V. Phone/Fax

Practice location:
  • Phone: 323-936-7525
  • Fax:
Mailing address:
  • Phone: 310-770-7586
  • Fax: 310-826-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT39223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: