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General NPI Number Information
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NPI Number | 1174170450
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Entity Type | Organization
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Legal Business Name | BEYOND PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 2990 S SEPULVEDA BLVD STE 205
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City | LOS ANGELES
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State | CA
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Zip | 90064-3973
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Country | US
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Telephone | 323-207-6809
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 MILLER DR APT 16
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-1441
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Country | US
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Telephone | 714-837-4681
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIMI P TON
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Credential | PT, DPT
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Telephone | 714-837-4681
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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 |
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License Number State |
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