MEDICARE: LEILANI KEIKO OKIHARA DPT, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	298789	CA

General Provider Information

NPI Number	:	1043824147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILANI KEIKO OKIHARA DPT, PT

Provider Business Mailing Address
First Line	:	17239 MOUNT STEPHEN AVE
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91387-3135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 MEDICAL CENTER DR STE 401
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4014
Country	:	US
Telephone Number	:	747-888-3562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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