=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205031994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLE LENORE STRAUB MS,PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 02/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 N PRAIRIE AVE SUITE A
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-4878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-673-9861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10627 ASHTON AVE #301
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90024-5096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-559-4102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT24466
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------