1164541157 NPI number — MARY JEANNE MILOSEVICH OTR/L

Table of content: MARY JEANNE MILOSEVICH OTR/L (NPI 1164541157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164541157 NPI number — MARY JEANNE MILOSEVICH OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILOSEVICH
Provider First Name:
MARY
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIMMERMAN
Provider Other First Name:
MARY
Provider Other Middle Name:
JEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164541157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 WEST AVE. M-14
Provider Second Line Business Mailing Address:
WEST POINT PHYSICAL THERAPY, INC
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-265-0060
Provider Business Mailing Address Fax Number:
661-265-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68845 PEREZ RD
Provider Second Line Business Practice Location Address:
STE H-6
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-7254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-328-0292
Provider Business Practice Location Address Fax Number:
760-328-9563
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  4308 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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