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General NPI Number Information
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NPI Number | 1356558209
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE INSTITUTE
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 14925 BURBANK BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-3610
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Country | US
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Telephone | 818-905-3355
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Fax | 818-905-0044
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Provider Business Mailing Address
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Address Line | 11693 SAN VICENTE BLVD # 523
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City | LOS ANGELES
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State | CA
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Zip | 90049-5105
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Country | US
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Telephone | 818-905-3355
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Fax | 818-905-0044
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Authorized Official
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Title or Position | PHYSICIAN ASST
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Name | MS. LILIAN M JENSEN
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Credential | PA-C
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Telephone | 818-905-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A61974
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License Number State | CA
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