Healthcare Provider Details

I. General information

NPI: 1053498246
Provider Name (Legal Business Name): VALERY MATSUMOTO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 SEPULVEDA BLVD UNIT A
CULVER CITY CA
90230-4715
US

IV. Provider business mailing address

4357 SEPULVEDA BLVD UNIT A
CULVER CITY CA
90230-4715
US

V. Phone/Fax

Practice location:
  • Phone: 310-391-1559
  • Fax: 310-398-9481
Mailing address:
  • Phone: 310-391-1559
  • Fax: 310-398-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: