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General NPI Number Information
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NPI Number | 1912459496
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Entity Type | Individual
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Provider Name | JESSICA HAWLEY-GAMER DPT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 415 N CRESCENT DR STE 130
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-6816
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Country | US
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Telephone | 541-579-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 6651 ENFIELD AVE
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City | RESEDA
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State | CA
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Zip | 91335-5609
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Country | US
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Telephone | 541-579-3411
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Fax |
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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 | 20-4169280
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License Number State | CA
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