Provider Demographics
NPI:1144379702
Name:EUBANKS, DARLENE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:MARIE
Last Name:EUBANKS
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 1:1524 ACACIA
Mailing Address - Street 2:APT 1
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3111
Mailing Address - Country:US
Mailing Address - Phone:323-304-5950
Mailing Address - Fax:
Practice Address - Street 1:6711 FOREST LAWN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1032
Practice Address - Country:US
Practice Address - Phone:323-851-7876
Practice Address - Fax:323-851-7870
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT24389AMedicare ID - Type Unspecified