MEDICARE: POSITIVE PHYSICAL THERAPY AND FITNESS INC

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	261QP2000X	Physical Therapy Clinic/Center	PT 39223	CA

General Provider Information

NPI Number	:	1023431046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PHYSICAL THERAPY AND FITNESS INC

Provider Business Mailing Address
First Line	:	5670 WILSHIRE BLVD STE 2170
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-5663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 BROADWAY
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2811
Country	:	US
Telephone Number	:	323-719-1758
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON WHITMAN
Credential	:	PT
Telephone Number	:	323-719-1758

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	05/13/2014

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