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13425 Ventura Blvd Ste 200, Sherman Oaks, CA 91423-3997 | |
(310) 871-9554 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 13425 Ventura Blvd Ste 200, Sherman Oaks, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1457692410 | NPI | - | NPPES |
WPT29666B | Other | CA | MEDICARE ID NUMBER |
Taxonomy | Type | License (State) | Status |
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225100000X | Physical Therapist | 29666 (California) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Nancy H Wong |
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Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1235644170 PECOS PAC ID: 7113287889 Enrollment ID: I20180129002257 |
Mailing Address | Practice Location Address |
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13425 Ventura Blvd Ste 200, Sherman Oaks, CA 91423-3997 Ph: (310) 871-9554 | 13425 Ventura Blvd Ste 200, Sherman Oaks, CA 91423-3997 Ph: (310) 871-9554 |