Provider Demographics
NPI:1245390020
Name:CHOI, EDDIE (PT)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S VIRGIL AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1405
Mailing Address - Country:US
Mailing Address - Phone:213-480-0021
Mailing Address - Fax:213-480-0621
Practice Address - Street 1:520 S VIRGIL AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1416
Practice Address - Country:US
Practice Address - Phone:213-480-0021
Practice Address - Fax:213-480-0621
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27249225100000X
IN05003434A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT27249AMedicare ID - Type UnspecifiedPPIN NUMBER