Provider Demographics
NPI:1124569926
Name:MARUSICH, KERSTI (DPT)
Entity Type:Individual
Prefix:
First Name:KERSTI
Middle Name:
Last Name:MARUSICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0235
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:424-203-8389
Practice Address - Street 1:5601 W SLAUSON AVE STE 125
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6588
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:424-203-8389
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM563231ZQ4JMedicare PIN