Provider Demographics
NPI:1356549687
Name:GEORGE, TELA R (PT)
Entity type:Individual
Prefix:
First Name:TELA
Middle Name:R
Last Name:GEORGE
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 1:4867 W SUNSET BLVD
Mailing Address - Street 2:7TH FLOOR PT DEPT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-783-8070
Mailing Address - Fax:323-783-5803
Practice Address - Street 1:4733 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6021
Practice Address - Country:US
Practice Address - Phone:323-783-4011
Practice Address - Fax:626-405-6768
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist