1699985879 NPI number — MRS. REBECCA FLEISHER TERRY P.T., O.C.S.

Table of content: MRS. REBECCA FLEISHER TERRY P.T., O.C.S. (NPI 1699985879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699985879 NPI number — MRS. REBECCA FLEISHER TERRY P.T., O.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRY
Provider First Name:
REBECCA
Provider Middle Name:
FLEISHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T., O.C.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TERRY
Provider Other First Name:
BETSY
Provider Other Middle Name:
FLEISHER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., O.C.S.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699985879
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:
19714 VINTAGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATSWORTH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91311-3549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-885-1734
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10780 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-4749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-474-5150
Provider Business Practice Location Address Fax Number:
310-474-4924
Provider Enumeration Date:
05/23/2007

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: 2251X0800X , with the licence number:  PT9306 , 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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