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NPI Code Detail

MEDICARE: LISA BRADFORD ULRICH PT

MEDICARE: LISA BRADFORD ULRICH PT
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
1225100000XPhysical TherapistPT25103CA

General Provider Information

NPI Number : 1336366947
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA BRADFORD ULRICH PT
Provider Business Mailing Address
First Line : 6962 W 85TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-2603
Country : US
Telephone Number : 310-890-7584
Fax Number : 310-642-1195
Provider Business Practice Location Address
First Line : 150 SIERRA ST
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-4117
Country : US
Telephone Number : 310-890-7584
Fax Number : 310-642-1195
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 01/14/2010

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Directions to “ LISA BRADFORD ULRICH PT” Practice Location

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