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NPI Code Detail

MEDICARE: DR. REUEL TIZABI PT, DPT

MEDICARE: DR. REUEL TIZABI PT, DPT
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
1225100000XPhysical TherapistPT297064CA

General Provider Information

NPI Number : 1790326791
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REUEL TIZABI PT, DPT
Provider Business Mailing Address
First Line : 5625 GREEN VALLEY CIR APT 210
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-7163
Country : US
Telephone Number : 240-994-4596
Fax Number :
Provider Business Practice Location Address
First Line : 615 N NASH ST STE 306
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-2850
Country : US
Telephone Number : 310-535-0008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2019
Last Update Date : 03/27/2025

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