Healthcare Provider Details

I. General information

NPI: 1720204852
Provider Name (Legal Business Name): FERDINAND A MERIOLES PT, MTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9353 IMPERIAL HWY PM&R GARDEN MEDICAL OFFICE ( 3RD FLOOR )
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

9353 IMPERIAL HWY PM&R GARDEN MEDICAL OFFICE ( 3RD FLOOR )
DOWNEY CA
90242-2812
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-4803
  • Fax:
Mailing address:
  • Phone: 562-657-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: