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General NPI Number Information
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NPI Number | 1225485436
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Entity Type | Organization
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Legal Business Name | HEREL PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 11427 CULVER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-6009
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Country | US
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Telephone | 607-761-4992
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Fax |
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Provider Business Mailing Address
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Address Line | 11911 SAN VICENTE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90049-5086
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Country | US
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Telephone | 607-761-4992
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. PHILLIP DANIEL HEREL
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Credential | DPT
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Telephone | 607-761-4992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 42569
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License Number State | CA
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