Provider Demographics
NPI:1245611961
Name:RON, SHANI (PT)
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:RON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANI
Other - Middle Name:
Other - Last Name:KORLANSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:811 S BEDFORD ST
Mailing Address - Street 2:APT 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1819
Mailing Address - Country:US
Mailing Address - Phone:310-623-7384
Mailing Address - Fax:
Practice Address - Street 1:811 S BEDFORD ST
Practice Address - Street 2:APT 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1819
Practice Address - Country:US
Practice Address - Phone:310-623-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist