Provider Demographics
NPI:1376768275
Name:LB PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LB PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-289-9775
Mailing Address - Street 1:11860 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6613
Mailing Address - Country:US
Mailing Address - Phone:310-312-1111
Mailing Address - Fax:
Practice Address - Street 1:11860 WILSHIRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6613
Practice Address - Country:US
Practice Address - Phone:310-312-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18954Medicare ID - Type UnspecifiedGROUP NUMBER