Healthcare Provider Details

I. General information

NPI: 1669504684
Provider Name (Legal Business Name): ERIC JOHN KAMAKEA M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N GLENDALE AVE
GLENDALE CA
91206-3311
US

IV. Provider business mailing address

380 W SAINT ANDREWS LN
AZUSA CA
91702-1445
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-9176
  • Fax:
Mailing address:
  • Phone: 562-760-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number29332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: