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General NPI Number Information
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NPI Number | 1588324131
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Entity Type | Organization
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Legal Business Name | ETHAN WALDMAN PHYSICAL THERAPY & WELLNESS INC
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 8107 DELGANY AVE
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7815
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Country | US
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Telephone | 310-720-6799
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Fax |
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Provider Business Mailing Address
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Address Line | 8107 DELGANY AVE
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7815
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Country | US
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Telephone | 310-720-6799
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | ETHAN WALDMAN
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Credential | PT
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Telephone | 310-720-6799
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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 |
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License Number State |
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