Individual ProviderEthan-Ira B MamuricPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address201 N Robertson Blvd, Beverly Hills, CA 90211-1729(424) 303-7647(908) 405-5947PECOS EnrollmentBased on the most recent information from CMS, provider Ethan-Ira B Mamuric does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1386306736Provider TypeIndividualFull NameMamuric, Ethan-Ira BTitleDr.CredentialDPTGenderMaleSole ProprietorNoEnumeration Date10/12/2021Last Updated10/12/2021Contact InformationPractice LocationPractice Address201 N Robertson Blvd, Beverly Hills, CA 90211-1729Phone(424) 303-7647FaxUnlisted FaxMailing LocationMailing Address360 S Detroit St, Los Angeles, CA 90036-3475Phone(908) 405-5947FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense301131California