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General NPI Number Information
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NPI Number | 1619244183
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Entity Type | Organization
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Legal Business Name | ANDREW PRITIKIN PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 1540 2ND ST SUITE 109A
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City | SANTA MONICA
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State | CA
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Zip | 90401-2303
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Country | US
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Telephone | 310-460-7490
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Fax | 310-434-1018
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Provider Business Mailing Address
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Address Line | 7537 W 85TH ST
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-8802
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Country | US
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Telephone | 310-649-5523
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Fax | 310-649-5523
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW PAUL PRITIKIN
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Credential | DPT
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Telephone | 310-649-5523
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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 | 35472
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License Number State | CA
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