Healthcare Provider Details

I. General information

NPI: 1881752103
Provider Name (Legal Business Name): AMY HIRATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: C. AMY HIRATA

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

IV. Provider business mailing address

1812 VERDUGO BLVD
GLENDALE CA
91208-1407
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-3545
  • Fax:
Mailing address:
  • Phone: 818-952-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: