NPIMap

Organization Active NPI

Performing Arts Physical Therapy of Los Angeles Inc

  • Physical Therapist
  • West Hollywood, CA
National Provider Identifier
1326085838
Registry record updated Oct 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT14633 Issued in CA
Legal business name
PERFORMING ARTS PHYSICAL THERAPY OF LOS ANGELES INC
Practice address
1106 N la Cienega Blvd Ste 203
West Hollywood, CA 90069-2493
Phone
(310) 659-1077
Fax
(310) 659-1163
NPI assigned
Jun 1, 2006
Last updated
Oct 31, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2018

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

Authorized official

Name
Melinda A Bryan, PT, DPTNPI 1114090016
Title
Owner, Ceo
Phone
(310) 659-1077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT14633 CA Primary

Addresses

Primary practice location

1106 N la Cienega Blvd Ste 203
West Hollywood, CA 90069-2493

Mailing address

1106 N la Cienega Blvd Ste 203
West Hollywood, CA 90069-2493
Phone (310) 659-1077

Other practice location 1

955 Carrillo Dr
#103
Los Angeles, CA 90048-5400
Phone (310) 659-1077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091113000490 CA Part B Supplier - Clinic/Group Practice 2668518044 Receives reassigned benefits from 9 practitioners
Practice locations: West Hollywood, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540944000000",
    "number": "1326085838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 N LA CIENEGA BLVD STE 203",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900692493",
            "telephone_number": "310-659-1077",
            "fax_number": "310-659-1163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 N LA CIENEGA BLVD STE 203",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900692493",
            "telephone_number": "310-659-1077",
            "fax_number": "310-659-1163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "955 Carrillo Dr",
            "address_2": "#103",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900485400",
            "country_code": "US",
            "telephone_number": "310-659-1077",
            "fax_number": "310-659-1163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PERFORMING ARTS PHYSICAL THERAPY OF LOS ANGELES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2018-10-31",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "310-659-1077",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.