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General NPI Number Information
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NPI Number | 1629298377
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Entity Type | Individual
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Provider Name | MARY LYNN O'CONNOR P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10605 BALBOA BLVD SUITE 300
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6342
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Country | US
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Telephone | 818-832-7200
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Fax | 818-832-7249
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Provider Business Mailing Address
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Address Line | 10765 CREBS AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91326-2764
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Country | US
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Telephone | 818-366-2588
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Fax | 818-366-2588
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT6090
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License Number State | CA
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