Ethan Waldman, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT291716 Issued in CA

Practice address

Engemann Health Ctr
1031 W. 34TH Street, Suite 450
Los Angeles, CA 90089-3261

Phone

(310) 720-6799

NPI assigned

Jun 15, 2016

Last updated

Aug 16, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ethan Waldman Physical Therapy & Wellness Inc

  • Physical Therapist
  • Playa del Rey, CA
  • NPI 1588324131
  Medicare reassignment NPD Authorized official
• Matrix Physical Therapy and Wellness, PC

  • Physical Therapy Clinic/Center
  • Santa Monica, CA
  • NPI 1790238418

  Physical Therapist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1235589839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8107 DELGANY AVE",
            "city": "PLAYA DEL REY",
            "state": "CA",
            "postal_code": "902937815",
            "telephone_number": "310-720-6799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ENGEMANN HEALTH CTR",
            "address_2": "1031 W. 34TH STREET, SUITE 450",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900893261",
            "telephone_number": "310-720-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDMAN",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "D.P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT291716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie Walden
• Daniela Walder, PSYD
• Elysa Waldholz, M.A., LMFT
• Lori Ann Waldinger
• Dorit Waldman
• Hadar Waldman, MD
• Lauren Alexandra Waldman, PA-C
• Talya Waldman, NURSE PRACTITIONER
• Doris Waldron, MD
• John D. Waldron, MD

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.