1447219035 NPI number — ANATOLIY PROKOPETS PHYSICAL THERAPIST

Table of content: ANATOLIY PROKOPETS PHYSICAL THERAPIST (NPI 1447219035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447219035 NPI number — ANATOLIY PROKOPETS PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROKOPETS
Provider First Name:
ANATOLIY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447219035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 N LA BREA AVE
Provider Second Line Business Mailing Address:
APT. 20
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90046-8318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-377-4691
Provider Business Mailing Address Fax Number:
323-874-3727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16108 PARTHENIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-481-2373
Provider Business Practice Location Address Fax Number:
818-830-4188
Provider Enumeration Date:
03/21/2006

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: 225100000X , with the licence number:  26042 , 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)





Copyright © 2007-2024 www.npivalidator.com