Healthcare Provider Details

I. General information

NPI: 1538671169
Provider Name (Legal Business Name): ANITA VERGIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21615 HAWTHORNE BLVD STE 200
TORRANCE CA
90503-6670
US

IV. Provider business mailing address

7405 N CEDAR AVE STE 103
FRESNO CA
93720-3838
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-8555
  • Fax:
Mailing address:
  • Phone: 559-261-4100
  • Fax: 559-261-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT293802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: