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General NPI Number Information
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NPI Number | 1033763933
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Entity Type | Organization
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Legal Business Name | JIM D. FERMO PHD
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 19934 LUBAO PL
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City | CHATSWORTH
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State | CA
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Zip | 91311-1818
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Country | US
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Telephone | 818-326-9499
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Fax | 818-368-7670
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Provider Business Mailing Address
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Address Line | 19934 LUBAO PL
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City | CHATSWORTH
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State | CA
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Zip | 91311-1818
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Country | US
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Telephone | 818-326-9499
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Fax | 818-368-7670
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Authorized Official
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Title or Position | DIRECTOR
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Name | JIM D FERMO
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Credential | PHD
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Telephone | 818-326-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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