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General NPI Number Information
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NPI Number | 1043645567
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Entity Type | Organization
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Legal Business Name | UEVOLUTION PT INC
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 621 S SPRING ST
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City | LOS ANGELES
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State | CA
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Zip | 90014-3908
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Country | US
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Telephone | 213-788-2773
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Fax |
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Provider Business Mailing Address
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Address Line | 621 S SPRING ST
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City | LOS ANGELES
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State | CA
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Zip | 90014-3908
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Country | US
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Telephone | 213-788-2773
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Fax |
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | MISS SERRYN TRACEY
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Credential |
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Telephone | 310-880-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 34748
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License Number State | CA
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