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General NPI Number Information
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NPI Number | 1659603108
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Entity Type | Individual
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Provider Name | ELISSA R. RYNEARSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 15805 S BUDLONG AVE
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City | GARDENA
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State | CA
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Zip | 90247-4303
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Country | US
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Telephone | 310-327-1758
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Fax |
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Provider Business Mailing Address
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Address Line | 20911 CATAMARAN LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-5517
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Country | US
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Telephone | 714-595-9246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT35066
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License Number State | CA
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