Healthcare Provider Details

I. General information

NPI: 1881848554
Provider Name (Legal Business Name): AKEOMAI PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 LINDERO CANYON ROAD
OAK PARK CA
91377
US

IV. Provider business mailing address

734 LINDERO CANYON ROAD
OAK PARK CA
91377
US

V. Phone/Fax

Practice location:
  • Phone: 818-824-4406
  • Fax:
Mailing address:
  • Phone: 818-824-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number34113
License Number StateCA

VIII. Authorized Official

Name: DR. JEREMY CARSCALLEN
Title or Position: PRESIDENT
Credential: DPT, CSCS
Phone: 818-824-4406