MEDICARE: ANN BASS 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	225100000X	Physical Therapist	PT6793	CA

General Provider Information

NPI Number	:	1215004684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN BASS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	626 WILSHIRE BLVD STE 460
Second Line	:	SUITE 460
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2917
Country	:	US
Telephone Number	:	213-689-1679
Fax Number	:	213-689-1084

Provider Business Practice Location Address
First Line	:	626 WILSHIRE BLVD STE 460
Second Line	:	SUITE 460
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2917
Country	:	US
Telephone Number	:	213-689-1679
Fax Number	:	213-689-1084

Authorized Official
Title or Position	:	OWNER
Name	:	ANN BASS
Credential	:	PT
Telephone Number	:	213-689-1679

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/22/2020

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