MEDICARE: SAMANTHA RAE KLAWIN HERRERA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	292151	CA

General Provider Information

NPI Number	:	1346799236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RAE KLAWIN HERRERA DPT

Provider Business Mailing Address
First Line	:	11600 WILSHIRE BLVD STE 222
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1782
Country	:	US
Telephone Number	:	424-248-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 WILSHIRE BLVD STE 222
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1782
Country	:	US
Telephone Number	:	424-248-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	04/27/2022

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