MEDICARE: ANN BASS 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	225100000X	Physical Therapist	PT6793	CA

General Provider Information

NPI Number	:	1588697460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN BASS PT

Provider Business Mailing Address
First Line	:	626 WILSHIRE BLVD
Second Line	:	SUITE 460
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3209
Country	:	US
Telephone Number	:	213-689-1679
Fax Number	:	213-689-1084

Provider Business Practice Location Address
First Line	:	626 WILSHIRE BLVD
Second Line	:	SUITE 460
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3209
Country	:	US
Telephone Number	:	213-689-1679
Fax Number	:	213-689-1084

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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Directions to “ ANN BASS PT” Practice Location

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