MEDICARE: INDEPENDENT PHYSICAL THERAPY 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1174608715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	PO BOX 235
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-0235
Country	:	US
Telephone Number	:	310-539-8800
Fax Number	:	310-698-5410

Provider Business Practice Location Address
First Line	:	1060 GLENDON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2908
Country	:	US
Telephone Number	:	310-539-8800
Fax Number	:	310-698-5410

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. THOMAS JAMES CIPOLLA
Credential	:
Telephone Number	:	310-539-8800

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/13/2021

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