MEDICARE: PT STOP PHYSICAL THERAPY & WELLNESS, 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
2	261QP2000X	Physical Therapy Clinic/Center	37956	CA

General Provider Information

NPI Number	:	1295275956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT STOP PHYSICAL THERAPY & WELLNESS, INC

Provider Business Mailing Address
First Line	:	6237 MORLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 W 6TH ST STE 514
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2552
Country	:	US
Telephone Number	:	888-444-0091
Fax Number	:	888-999-0071

Authorized Official
Title or Position	:	OWNER
Name	:	MAYAMI OYANAGI
Credential	:	PT
Telephone Number	:	617-869-2285

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	03/21/2018

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