MEDICARE: LORI RUBENSTEIN FAZZIO 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
1	174400000X	Specialist	PT 14694	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WPT14694A	OTHER	CA	MEDICARE PTAN
2	W16543	OTHER	CA	MEDICARE CORPORATION GROUP PTAN

General Provider Information

NPI Number	:	1427129642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI RUBENSTEIN FAZZIO PT

Provider Business Mailing Address
First Line	:	PO BOX 641428
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-6428
Country	:	US
Telephone Number	:	310-401-6410
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 W OLYMPIC BLVD
Second Line	:	SUITE 135E
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5001
Country	:	US
Telephone Number	:	310-401-6410
Fax Number	:	310-312-3637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	01/27/2015

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Directions to “ LORI RUBENSTEIN FAZZIO PT” Practice Location

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