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General NPI Number Information
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NPI Number | 1255456752
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Entity Type | Individual
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Provider Name | NOVO F BANTOLO PT
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 6033 W CENTURY BLVD SUITE 200 & 201
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City | LOS ANGELES
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State | CA
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Zip | 90045-6410
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Country | US
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Telephone | 615-778-4066
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Fax | 615-778-9114
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Provider Business Mailing Address
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Address Line | 720 COOL SPRINGS BLVD SUITE 300
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City | FRANKLIN
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State | TN
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Zip | 37067-2626
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Country | US
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Telephone | 615-778-4066
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Fax | 615-778-9114
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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 | PT 32795
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License Number State | CA
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