Healthcare Provider Details

I. General information

NPI: 1285464859
Provider Name (Legal Business Name): ADRIANA ARDILA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S FAIR OAKS AVE # 110
PASADENA CA
91105-2614
US

IV. Provider business mailing address

13901 GILMORE ST
VAN NUYS CA
91401
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7620
  • Fax:
Mailing address:
  • Phone: 305-469-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: