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General NPI Number Information
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NPI Number | 1154799153
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Entity Type | Organization
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Legal Business Name | CHOE PENNELLA PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 700 WILSHIRE BLVD SUITE 505
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City | LOS ANGELES
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State | CA
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Zip | 90017-3811
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Country | US
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Telephone | 847-691-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 700 WILSHIRE BLVD SUITE 505
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City | LOS ANGELES
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State | CA
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Zip | 90017-3811
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Country | US
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Telephone | 847-691-0032
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL CHOE
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Credential | DPT
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Telephone | 847-691-0032
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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 | 40535
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License Number State | CA
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