Healthcare Provider Details

I. General information

NPI: 1407511850
Provider Name (Legal Business Name): JEFFREY ISAAC RYEMON PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30870 RUSSELL RANCH RD STE 330
WESTLAKE VILLAGE CA
91362-7372
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: