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General NPI Number Information
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NPI Number | 1588943104
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Entity Type | Organization
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Legal Business Name | LIFE ENERGY PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 1917 HILLHURST AVE STE 201
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City | LOS ANGELES
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State | CA
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Zip | 90027-2711
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Country | US
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Telephone | 323-680-5378
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Fax | 323-657-5378
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Provider Business Mailing Address
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Address Line | 15149 SYLVAN ST
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City | VAN NUYS
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State | CA
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Zip | 91411-1918
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Country | US
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Telephone | 323-680-5378
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Fax | 323-657-5378
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ELIZABETH DOVLATYAN
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Credential | DPT
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Telephone | 323-680-5378
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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 | 35464
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License Number State | CA
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