Healthcare Provider Details

I. General information

NPI: 1306983911
Provider Name (Legal Business Name): WHOLISTIC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 EAGLE ROCK BLVD SUITE 7
LOS ANGELES CA
90065-4492
US

IV. Provider business mailing address

4157 EAGLE ROCK BLVD SUITE 7
LOS ANGELES CA
90065-4492
US

V. Phone/Fax

Practice location:
  • Phone: 323-982-1566
  • Fax: 323-982-1680
Mailing address:
  • Phone: 323-982-1566
  • Fax: 323-982-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ALLAN S SAMIA
Title or Position: PRESIDENT CEO
Credential:
Phone: 323-982-1566