Organization
OUR LADY OF PROVIDENCE PHYSICAL THERAPY CLINIC
Active
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
Update your record
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