Organization
OUR LADY OF PROVIDENCE PHYSICAL THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARCELLE DEAIBES R.P.T (PRESIDENT/DIRECTOR)
(818) 506-4119
Entity
Organization
Contact information
Practice address
10843 MAGNOLIA BLVD STE 2, NORTH HOLLYWOOD, CA 91601-3922
(818) 506-4119
(818) 506-8115
Mailing address
10843 MAGNOLIA BLVD STE 2, NORTH HOLLYWOOD, CA 91601-3922
(818) 506-4119
(818) 506-8115
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT 18580
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ08154Z
PHYSICAL THERAPY
CA
Enumeration date
07/09/2006
Last updated
08/22/2020
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