Provider Demographics
NPI:1518550896
Name:SHULL, GEORGE REESE (DPT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:REESE
Last Name:SHULL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16573 VENTURA BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2024
Mailing Address - Country:US
Mailing Address - Phone:818-986-7266
Mailing Address - Fax:
Practice Address - Street 1:16573 VENTURA BLVD STE 8
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2024
Practice Address - Country:US
Practice Address - Phone:818-986-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist