Provider Demographics
NPI:1235259292
Name:ADOREMOS, MARY SHELLAH ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:MARY SHELLAH
Middle Name:ELIZABETH
Last Name:ADOREMOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY SHELLAH
Other - Middle Name:ELIZABETH
Other - Last Name:MALANYAON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 N VERDUGO RD
Mailing Address - Street 2:APT 1
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:747-228-9654
Mailing Address - Fax:
Practice Address - Street 1:7727 LOUISE AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4524
Practice Address - Country:US
Practice Address - Phone:818-235-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5252225100000X
CA33870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist