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General NPI Number Information
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NPI Number | 1093872293
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Entity Type | Organization
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Legal Business Name | WAKSMAN PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 12526 RIVERSIDE DR
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3409
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Country | US
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Telephone | 818-985-2559
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Fax | 818-985-4459
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Provider Business Mailing Address
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Address Line | 12526 RIVERSIDE DR
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3409
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Country | US
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Telephone | 818-985-2559
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Fax | 818-985-4459
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MILANA WAKSMAN
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Credential | R.P.T.
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Telephone | 818-985-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT-25978
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License Number State | CA
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