Healthcare Provider Details

I. General information

NPI: 1689246407
Provider Name (Legal Business Name): LISA SCHMALZRIED DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 WILSHIRE BLVD
SANTA MONICA CA
90403-2301
US

IV. Provider business mailing address

1706 COMSTOCK AVE
LOS ANGELES CA
90024-5323
US

V. Phone/Fax

Practice location:
  • Phone: 310-264-8385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: