| NPI | 1104816057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RAYMOND Physician 323-465-9180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA PT22017) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2019-03-07 |