Healthcare Provider Details

I. General information

NPI: 1962276485
Provider Name (Legal Business Name): KAM PHYSICAL THERAPY & PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 JASMINE AVE APT 401
LOS ANGELES CA
90034-4246
US

IV. Provider business mailing address

3672 JASMINE AVE APT 401
LOS ANGELES CA
90034-4246
US

V. Phone/Fax

Practice location:
  • Phone: 909-289-6200
  • Fax:
Mailing address:
  • Phone: 909-289-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAMREN ACKERMAN
Title or Position: PRESIDENT
Credential: DPT
Phone: 909-289-6200