MEDICARE: MADE IN LA PT 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	111N00000X	Chiropractor
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1831367135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADE IN LA PT INC

Provider Business Mailing Address
First Line	:	6741 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4604
Country	:	US
Telephone Number	:	323-461-1990
Fax Number	:	323-461-1995

Provider Business Practice Location Address
First Line	:	6741 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-4604
Country	:	US
Telephone Number	:	323-461-1990
Fax Number	:	323-461-1995

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	ANDREA LAWENT
Credential	:
Telephone Number	:	323-499-1990

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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Directions to “MADE IN LA PT INC ” Practice Location

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