Provider Demographics
NPI:1659300507
Name:PHYSICAL THERAPY SPECIALISTS INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, OCS
Authorized Official - Phone:310-273-8256
Mailing Address - Street 1:200 N ROBERTSON BLVD
Mailing Address - Street 2:#301
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1769
Mailing Address - Country:US
Mailing Address - Phone:310-273-8256
Mailing Address - Fax:310-273-8542
Practice Address - Street 1:200 N ROBERTSON BLVD
Practice Address - Street 2:#301
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1769
Practice Address - Country:US
Practice Address - Phone:310-273-8256
Practice Address - Fax:310-273-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14856Medicare ID - Type Unspecified