Provider Demographics
NPI:1134527393
Name:PT WORKS PLUS
Entity type:Organization
Organization Name:PT WORKS PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DRAVILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-260-9039
Mailing Address - Street 1:719 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2601
Mailing Address - Country:US
Mailing Address - Phone:310-260-9039
Mailing Address - Fax:310-260-1091
Practice Address - Street 1:719 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2601
Practice Address - Country:US
Practice Address - Phone:310-260-9039
Practice Address - Fax:310-260-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-22
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
CAWPT32913BOtherPTAN
CAP429063Medicare UPIN
CAP43120Medicare UPIN