MEDICARE: STAY READY PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	PT28757	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT28757	OTHER	CA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1023215530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAY READY PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	11819 WILSHIRE BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6619
Country	:	US
Telephone Number	:	323-936-7525
Fax Number	:	323-936-7572

Provider Business Practice Location Address
First Line	:	11819 WILSHIRE BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6619
Country	:	US
Telephone Number	:	323-936-7525
Fax Number	:	323-936-7572

Authorized Official
Title or Position	:	OWNER
Name	:	AMAN ABYE
Credential	:
Telephone Number	:	323-936-7525

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	08/22/2020

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Directions to “STAY READY PHYSICAL THERAPY ” Practice Location

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