=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952620437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REISS PHYSICAL THERAPY & REHAB, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2010
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 N PALM DRIVE 207
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-3951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-965-7713
-----------------------------------------------------
Fax | 323-978-6860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 432 N PALM DR 207
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-3951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-965-7713
-----------------------------------------------------
Fax | 323-978-6860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DIANA A REISS
-----------------------------------------------------
Credential | PT, DPT, OCS
-----------------------------------------------------
Telephone | 323-965-7713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 29826
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------