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General NPI Number Information
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NPI Number | 1235589839
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Entity Type | Individual
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Provider Name | ETHAN WALDMAN D.P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | ENGEMANN HEALTH CTR 1031 W. 34TH STREET, SUITE 450
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City | LOS ANGELES
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State | CA
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Zip | 90089-3261
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Country | US
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Telephone | 310-720-6799
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Fax |
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Provider Business Mailing Address
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Address Line | 8107 DELGANY AVE
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7815
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Country | US
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Telephone | 310-720-6799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT291716
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License Number State | CA
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