MEDICARE: EQUIP PHYSICAL THERAPY AND REHABILITATION 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	225100000X	Physical Therapist	292473	CA

General Provider Information

NPI Number	:	1831625839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUIP PHYSICAL THERAPY AND REHABILITATION INC

Provider Business Mailing Address
First Line	:	505 S VIRGIL AVE STE 204A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1443
Country	:	US
Telephone Number	:	213-674-7699
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 S VIRGIL AVE STE 204A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1443
Country	:	US
Telephone Number	:	213-674-7699
Fax Number	:

Authorized Official
Title or Position	:	DPT
Name	:	MICHAEL KANG
Credential	:
Telephone Number	:	213-249-1150

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	04/26/2023

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