MEDICARE: SPOT 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

General Provider Information

NPI Number	:	1972186633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOT PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	411 S CENTRAL AVE.
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1601
Country	:	US
Telephone Number	:	818-452-2722
Fax Number	:	818-272-8632

Provider Business Practice Location Address
First Line	:	411 S CENTRAL AVE.
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1601
Country	:	US
Telephone Number	:	818-940-6015
Fax Number	:	818-272-8632

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID DALLAKIAN
Credential	:
Telephone Number	:	818-452-2722

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/30/2021

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Directions to “SPOT PHYSICAL THERAPY INC ” Practice Location

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