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General NPI Number Information
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NPI Number | 1437407335
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Entity Type | Organization
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Legal Business Name | PRODYNAMICS INC.
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 12099 W WASHINGTON BLVD STE 408
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City | LOS ANGELES
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State | CA
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Zip | 90066-2620
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Country | US
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Telephone | 424-228-4340
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Fax | 424-228-4109
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Provider Business Mailing Address
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Address Line | 12099 W WASHINGTON BLVD STE 408
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City | LOS ANGELES
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State | CA
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Zip | 90066-2620
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Country | US
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Telephone | 424-228-4340
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Fax | 424-228-4109
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PAUL DAWSON
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Credential | PHYSICAL THERAPIST
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Telephone | 424-228-4340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 27141
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License Number State | CA
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