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General NPI Number Information
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NPI Number | 1619923059
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Entity Type | Organization
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Legal Business Name | CORPUS ART PHYSICAL THERAPY PROFESSIONAL CORP
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11860 WILSHIRE BLVD 100
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City | LOS ANGELES
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State | CA
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Zip | 90025-6613
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Country | US
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Telephone | 310-312-1111
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Fax | 310-312-1139
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Provider Business Mailing Address
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Address Line | 11860 WILSHIRE BLVD 100
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City | LOS ANGELES
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State | CA
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Zip | 90025-6613
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Country | US
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Telephone | 310-312-1111
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Fax | 310-312-1139
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Authorized Official
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Title or Position | PRESIDENT
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Name | VLADISLAV SHUB
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Credential | P.T.
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Telephone | 310-312-1111
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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 |
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License Number State |
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