Provider Demographics
NPI:1588697460
Name:BASS, ANN (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BASS
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 1:626 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3209
Mailing Address - Country:US
Mailing Address - Phone:213-689-1679
Mailing Address - Fax:213-689-1084
Practice Address - Street 1:626 WILSHIRE BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3209
Practice Address - Country:US
Practice Address - Phone:213-689-1679
Practice Address - Fax:213-689-1084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT6793AMedicare ID - Type Unspecified