Provider Demographics
NPI:1841421153
Name:WARE, ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:WARE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 OCEAN PARK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5217
Mailing Address - Country:US
Mailing Address - Phone:310-392-0025
Mailing Address - Fax:310-392-0026
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 407
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4669
Practice Address - Country:US
Practice Address - Phone:818-244-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist