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Organization
DACOSTA COLLYMORE
Active
Organization
DACOSTA COLLYMORE
Active
Other names
Pacific Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DACOSTA ALONZO COLLYMORE RPT (CEO OWNER)
(310) 836-7650
Entity
Organization
Contact information
Practice address
5000 OVERLAND AVE, #4, CULVER CITY, CA 90230
(310) 836-7650
(310) 836-7651
Mailing address
5000 OVERLAND AVE, #4, CULVER CITY, CA 90230
(310) 836-7650
(310) 836-7651
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20709
CA
Other
Enumeration date
12/04/2007
Last updated
06/24/2008
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