Healthcare Provider Details

I. General information

NPI: 1952900789
Provider Name (Legal Business Name): SIERRA SPECK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 WILSHIRE BLVD STE 14B1
LOS ANGELES CA
90025-1547
US

IV. Provider business mailing address

3847 TILDEN AVE APT 4
CULVER CITY CA
90232-3948
US

V. Phone/Fax

Practice location:
  • Phone: 323-936-7525
  • Fax:
Mailing address:
  • Phone: 440-666-4568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number299140
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: