Healthcare Provider Details

I. General information

NPI: 1306385679
Provider Name (Legal Business Name): MANREET SANGHA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2017
Last Update Date: 02/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 MAJOR ST
LOS ANGELES CA
90230-6356
US

IV. Provider business mailing address

915 ARIZONA AVE 7
SANTA MONICA CA
90401-1850
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax:
Mailing address:
  • Phone: 971-222-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: