MEDICARE: NEW WELLNESS INSTITUTE OF 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	261QP2000X	Physical Therapy Clinic/Center	PT 19584	CA

General Provider Information

NPI Number	:	1871876326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW WELLNESS INSTITUTE OF PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	12568 WEST WASINGTON BLVD
Second Line	:	SUITE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12568 W WASHINGTON BLVD
Second Line	:	SUITE 202
City	:	CULVER CITY
State	:	CA
Zip	:	90066
Country	:	US
Telephone Number	:	310-482-3252
Fax Number	:

Authorized Official
Title or Position	:	DPT
Name	:	DR. DIMITRI RIMSKY
Credential	:
Telephone Number	:	310-200-5879

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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