Provider Demographics
NPI:1083761209
Name:ADOLPHI, LEIZL-ANN M (PT)
Entity Type:Individual
Prefix:
First Name:LEIZL-ANN
Middle Name:M
Last Name:ADOLPHI
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 1:265 N EUCLID AVE
Mailing Address - Street 2:#202
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1594
Mailing Address - Country:US
Mailing Address - Phone:626-356-4948
Mailing Address - Fax:
Practice Address - Street 1:265 N EUCLID AVE
Practice Address - Street 2:#202
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1594
Practice Address - Country:US
Practice Address - Phone:626-356-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA841703311OtherTAX IDENTIFICATION NUMBER
CAWPT20048FMedicare ID - Type UnspecifiedMEDICARE NUMBER