MEDICARE: MARY ROSENBERG 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	:	1649374919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY ROSENBERG PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	SUITE 815
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6935
Country	:	US
Telephone Number	:	323-957-9571
Fax Number	:	323-957-9583

Provider Business Practice Location Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	SUITE 815
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6935
Country	:	US
Telephone Number	:	323-957-9571
Fax Number	:	323-957-9583

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARY K ROSENBERG
Credential	:	PT LATC SA
Telephone Number	:	323-957-9571

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	08/22/2020

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