Provider Demographics
NPI:1831213172
Name:WEISMAN, JILL (PT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5781
Mailing Address - Country:US
Mailing Address - Phone:310-477-8622
Mailing Address - Fax:310-479-8238
Practice Address - Street 1:11600 WILSHIRE BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5781
Practice Address - Country:US
Practice Address - Phone:310-477-8622
Practice Address - Fax:310-479-8238
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT10329AMedicare PIN
CAP00335893Medicare PIN
CAWPT10329AMedicare PIN