MEDICARE: PHYSICAL THERAPY INTEGRATED SERVICES 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

General Provider Information

NPI Number	:	1558554238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY INTEGRATED SERVICES INC

Provider Business Mailing Address
First Line	:	1501 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1424
Country	:	US
Telephone Number	:	818-793-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1424
Country	:	US
Telephone Number	:	818-793-1615
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ARLINE S ALFONSO
Credential	:
Telephone Number	:	818-793-1615

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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