Individual
CLEV PAET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT ASSISTANT
Contact information
Practice address
7716 W MANCHESTER AVE, PLAYA DEL REY, CA 90293-8408
(310) 823-4694
Mailing address
7716 W MANCHESTER AVE, PLAYA DEL REY, CA 90293-8408
(310) 823-4694
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 3292
CA
Other
Enumeration date
10/09/2014
Last updated
10/09/2014
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