MEDICARE: PON PHYSICAL THERAPY 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	261QP2000X	Physical Therapy Clinic/Center	PT18593	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	610466700	OTHER	CA	US DEPT OF LABOR
2	OPT185930	OTHER	CA	BS OF CA

General Provider Information

NPI Number	:	1952388639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PON PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	1944 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1644
Country	:	US
Telephone Number	:	818-846-3385
Fax Number	:	818-334-4922

Provider Business Practice Location Address
First Line	:	1944 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1644
Country	:	US
Telephone Number	:	818-846-3385
Fax Number	:	818-334-4922

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GILBERT J PON
Credential	:
Telephone Number	:	818-846-3385

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	02/13/2014

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1235081985 — LOUIZA LANA AZIZIAN
Practice Location Address:

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Directions to “PON PHYSICAL THERAPY INC ” Practice Location

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