Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Jul 11, 2022
License(s)
302215 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 719 SANTA MONICA BLVD | Santa Monica, CA 90401-2601 | 310-260-9039 |
| MAILING | 2560 S BARRINGTON AVE APT 105 | Los Angeles, CA 90064-2863 | 530-774-7064 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.