Provider Demographics
NPI:1093925513
Name:PASSEY, KAREN A I (MPT)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:A
Last Name:PASSEY
Suffix:I
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 N SEPULVEDA BLVD
Mailing Address - Street 2:#9
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2913
Mailing Address - Country:US
Mailing Address - Phone:310-463-6204
Mailing Address - Fax:
Practice Address - Street 1:2407 N SEPULVEDA BLVD
Practice Address - Street 2:#9
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2913
Practice Address - Country:US
Practice Address - Phone:310-463-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16381Medicare ID - Type Unspecified