Healthcare Provider Details

I. General information

NPI: 1689725863
Provider Name (Legal Business Name): PILAR MARIE HANES MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 COCHRAN ST
SIMI VALLEY CA
93065-2775
US

IV. Provider business mailing address

PO BOX 1448
SIMI VALLEY CA
93062-1448
US

V. Phone/Fax

Practice location:
  • Phone: 805-583-9575
  • Fax: 805-583-9578
Mailing address:
  • Phone: 805-583-9575
  • Fax: 805-583-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT26886
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: