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General NPI Number Information
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NPI Number | 1154775120
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Entity Type | Organization
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Legal Business Name | DASH PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 11600 WILSHIRE BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-1782
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Country | US
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Telephone | 917-324-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 LAMBIANCE CIR APT 102
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City | NAPLES
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State | FL
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Zip | 34108-6738
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARISA DADAMO
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Credential |
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Telephone | 917-324-5358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 291214
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License Number State | CA
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