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General NPI Number Information
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NPI Number | 1891145108
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Entity Type | Organization
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Legal Business Name | SOUTH PACIFIC PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 4940 VAN NUYS BLVD #301
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1700
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Country | US
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Telephone | 818-907-0952
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Fax |
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Provider Business Mailing Address
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Address Line | 16161 VENTURA BLVD # C564
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City | ENCINO
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State | CA
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Zip | 91436-2522
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Country | US
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Telephone | 818-907-0952
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DOREEN AKRY
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Credential | DPT
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Telephone | 818-907-0952
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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 | PT36911
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License Number State | CA
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