Provider Demographics
NPI:1689638637
Name:KATHLEEN A WHOOLEY PT OCS
Entity Type:Organization
Organization Name:KATHLEEN A WHOOLEY PT OCS
Other - Org Name:LARCHMONT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:323-464-4458
Mailing Address - Street 1:321 N LARCHMONT BLVD STE 825
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6400
Mailing Address - Country:US
Mailing Address - Phone:323-464-4458
Mailing Address - Fax:323-464-5329
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:SUITE #825
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3025
Practice Address - Country:US
Practice Address - Phone:323-464-4458
Practice Address - Fax:323-464-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2022-08-11
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
CAWPT20371AMedicare ID - Type UnspecifiedPHYSICAL THERAPY
CAW15008Medicare ID - Type UnspecifiedPHYSICAL THERAPY
CAPT8914AMedicare ID - Type UnspecifiedPHYSICAL THERAPY
CAWPT2866AMedicare ID - Type UnspecifiedPHYSICAL THERAPY