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General NPI Number Information
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NPI Number | 1659584662
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Entity Type | Organization
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Legal Business Name | PHYSICIAN THERAPEUTICS LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-474-9809
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Fax | 310-531-7089
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-474-9809
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Fax | 310-531-7089
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM ELSON SHELL
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Credential | M.D.
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Telephone | 310-474-9809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | C32361
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License Number State | CA
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