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General NPI Number Information
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NPI Number | 1518150788
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Entity Type | Individual
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Provider Name | EDWARD JEROME MANN P.T.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE PHYSICAL THERAPY DEPARTMENT
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2476
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Fax |
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Provider Business Mailing Address
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Address Line | 734 SAN LORENZO ST
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City | SANTA MONICA
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State | CA
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Zip | 90402-1324
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Country | US
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Telephone | 805-234-6321
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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 | PT21241
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License Number State | CA
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