MEDICARE: GILLESPIE 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

General Provider Information

NPI Number	:	1386314185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILLESPIE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	601 21ST PL
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-3049
Country	:	US
Telephone Number	:	310-922-3096
Fax Number	:	310-861-8553

Provider Business Practice Location Address
First Line	:	312 S CATALINA AVE STE E
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3622
Country	:	US
Telephone Number	:	424-353-9791
Fax Number	:	310-861-8553

Authorized Official
Title or Position	:	CEO
Name	:	JULIE REYNOLDS
Credential	:
Telephone Number	:	424-353-9791

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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Directions to “GILLESPIE PHYSICAL THERAPY ” Practice Location

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