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General NPI Number Information
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NPI Number | 1588428262
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Entity Type | Organization
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Legal Business Name | EXPANSE WELLNESS ACUPUNCTURE AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 13906 FIJI WAY APT 352
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6934
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Country | US
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Telephone | 818-373-9014
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Fax |
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Provider Business Mailing Address
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Address Line | 13906 FIJI WAY APT 352
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6934
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Country | US
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Telephone | 818-373-9014
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WENDY CHAN
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Credential | DPT, LAC, DIPL OM
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Telephone | 818-373-9014
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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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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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