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General NPI Number Information
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NPI Number | 1689119232
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Entity Type | Organization
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Legal Business Name | MKSDPT INC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 8500 WILSHIRE BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3121
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Country | US
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Telephone | 310-659-3389
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Fax |
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Provider Business Mailing Address
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Address Line | 654 W WILSON ST
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City | COSTA MESA
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State | CA
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Zip | 92627-2469
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Country | US
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Telephone | 949-933-9630
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW SZKALAK
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Credential | DPT
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Telephone | 949-933-9630
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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 | PT36431
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License Number State | CA
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