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General NPI Number Information
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NPI Number | 1215796032
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Entity Type | Organization
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Legal Business Name | REPLENISH PHYSICAL THERAPY & DANCE PERFORMANCE PC
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 25830 OAK ST UNIT 7
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City | LOMITA
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State | CA
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Zip | 90717-3121
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Country | US
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Telephone | 310-922-3526
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 LOMITA BLVD # 512
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City | LOMITA
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State | CA
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Zip | 90717-1701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HILARY PAIGE GEREAUX VAN DIXHORN
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Credential | PT, DPT
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Telephone | 310-922-3526
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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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