Healthcare Provider Details

I. General information

NPI: 1972871184
Provider Name (Legal Business Name): JOHN LANDEENE MEYER DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 S SEPULVEDA BLVD
LOS ANGELES CA
90045-4833
US

IV. Provider business mailing address

330 33RD ST
HERMOSA BEACH CA
90254-2155
US

V. Phone/Fax

Practice location:
  • Phone: 213-725-3043
  • Fax: 310-626-9880
Mailing address:
  • Phone: 213-725-3043
  • Fax: 310-626-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number23612
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: