Provider Demographics
NPI:1619244183
Name:ANDREW PRITIKIN PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ANDREW PRITIKIN PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PRITIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-649-5523
Mailing Address - Street 1:7537 W 85TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8802
Mailing Address - Country:US
Mailing Address - Phone:310-649-5523
Mailing Address - Fax:310-649-5523
Practice Address - Street 1:1540 2ND ST
Practice Address - Street 2:SUITE 109A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2303
Practice Address - Country:US
Practice Address - Phone:310-460-7490
Practice Address - Fax:310-434-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty