Healthcare Provider Details

I. General information

NPI: 1225190473
Provider Name (Legal Business Name): PHYSICIANS PHYSICAL THERAPY SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 SANTA MONICA BLVD SUITE 435
LOS ANGELES CA
90025-6932
US

IV. Provider business mailing address

10474 SANTA MONICA BLVD SUITE 435
LOS ANGELES CA
90025-6932
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-4137
  • Fax: 310-274-1815
Mailing address:
  • Phone: 310-275-4137
  • Fax: 310-274-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT1438
License Number StateCA

VIII. Authorized Official

Name: DR. JOSE RAUL LONA
Title or Position: OWNER
Credential: P.T.
Phone: 310-275-4137