Healthcare Provider Details

I. General information

NPI: 1851734057
Provider Name (Legal Business Name): VERT PHYSICAL THERAPY LA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 12/15/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18420 HART ST
RESEDA CA
91335-4317
US

IV. Provider business mailing address

12021 WILSHIRE BLVD STE 187
LOS ANGELES CA
90025-1206
US

V. Phone/Fax

Practice location:
  • Phone: 818-344-8378
  • Fax:
Mailing address:
  • Phone: 310-264-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPT24176
License Number StateCA

VIII. Authorized Official

Name: KEVIN THEIS
Title or Position: PARTNER
Credential:
Phone: 818-344-8378