MEDICARE: HPE-HUMAN PERFORMANCE ENHANCEMENT, 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	:	1407007511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HPE-HUMAN PERFORMANCE ENHANCEMENT, INC.

Provider Business Mailing Address
First Line	:	1500 ROSECRANS AVE
Second Line	:	SUITE 500
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3763
Country	:	US
Telephone Number	:	310-980-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 ROSECRANS AVE
Second Line	:	SUITE 500
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3763
Country	:	US
Telephone Number	:	310-980-0403
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SHY SHALOM AZOULAY
Credential	:	BA
Telephone Number	:	310-980-0403

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	06/08/2012

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