Healthcare Provider Details

I. General information

NPI: 1538476684
Provider Name (Legal Business Name): SONJA ANDREA REESE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11353 OVADA PT. #7
LOS ANGELES CA
90049
US

IV. Provider business mailing address

11353 OVADA PT. #7
LOS ANGELES CA
90049
US

V. Phone/Fax

Practice location:
  • Phone: 310-570-7640
  • Fax:
Mailing address:
  • Phone: 310-570-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number21150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: