Provider Demographics
NPI:1093046419
Name:PRITIKIN, ANDREW PAUL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:PRITIKIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12401 WILSHIRE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1015
Mailing Address - Country:US
Mailing Address - Phone:310-826-4100
Mailing Address - Fax:424-832-3395
Practice Address - Street 1:12401 WILSHIRE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1015
Practice Address - Country:US
Practice Address - Phone:424-832-7211
Practice Address - Fax:424-832-3395
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35472225200000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant