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General NPI Number Information
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NPI Number | 1558022004
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Entity Type | Organization
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Legal Business Name | PURE WELLNESS, INC.
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 14600 SHERMAN WAY STE 300
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City | VAN NUYS
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State | CA
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Zip | 91405-2272
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Country | US
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Telephone | 818-781-7097
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 W 6TH ST # 2-105
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City | LOS ANGELES
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State | CA
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Zip | 90036-3361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ PHYSICAL THERAPIST
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Name | JODI-ANN FOSTER
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Credential | PT, DPT
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Telephone | 213-713-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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