=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912138298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L.A.P.T & REHAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2009
-----------------------------------------------------
Last Update Date | 08/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1127 WILSHIRE BLVD STE 805
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-250-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19528 VENTURA BLVD # 494
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | IRENE GAMPEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-355-8868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 14377
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------