Healthcare Provider Details

I. General information

NPI: 1487942405
Provider Name (Legal Business Name): CAROLINE S HSU DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11677 SAN VICENTE BLVD #207
LOS ANGELES CA
90049-5123
US

IV. Provider business mailing address

548 S SPRING ST APT 707
LOS ANGELES CA
90013-2307
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-3110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: