Provider Demographics
NPI:1053498246
Name:MATSUMOTO, VALERY (PT)
Entity Type:Individual
Prefix:MS
First Name:VALERY
Middle Name:
Last Name:MATSUMOTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4357 SEPULVEDA BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4715
Mailing Address - Country:US
Mailing Address - Phone:310-391-1559
Mailing Address - Fax:310-398-9481
Practice Address - Street 1:4357 SEPULVEDA BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4715
Practice Address - Country:US
Practice Address - Phone:310-391-1559
Practice Address - Fax:310-398-9481
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist