Healthcare Provider Details

I. General information

NPI: 1730237223
Provider Name (Legal Business Name): KAREN SEADE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 OAK ST
SANTA MONICA CA
90405-4802
US

IV. Provider business mailing address

1650 OAK ST
SANTA MONICA CA
90405-4802
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-6222
  • Fax: 310-478-6696
Mailing address:
  • Phone: 310-478-6222
  • Fax: 310-478-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: