Provider Demographics
NPI:1447321666
Name:LORI RUBENSTEIN PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:LORI RUBENSTEIN PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAZZIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-401-6410
Mailing Address - Street 1:PO BOX 641428
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-6428
Mailing Address - Country:US
Mailing Address - Phone:310-401-6410
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 135E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5001
Practice Address - Country:US
Practice Address - Phone:310-401-6410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14694OtherPT LICENSE
W16543Medicare PIN
CAPT14694OtherPT LICENSE