Provider Demographics
NPI:1295275956
Name:PT STOP PHYSICAL THERAPY & WELLNESS, INC
Entity type:Organization
Organization Name:PT STOP PHYSICAL THERAPY & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OYANAGI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-869-2285
Mailing Address - Street 1:6237 MORLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3407 W 6TH ST STE 514
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2552
Practice Address - Country:US
Practice Address - Phone:888-444-0091
Practice Address - Fax:888-999-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
CA37956261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy