Provider Demographics
NPI:1407394885
Name:MILANO, MARCO (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:MILANO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 S BEVERLY GLEN BLVD
Mailing Address - Street 2:205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6050
Mailing Address - Country:US
Mailing Address - Phone:310-531-3842
Mailing Address - Fax:
Practice Address - Street 1:2901 OCEAN PARK BLVD
Practice Address - Street 2:212
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2919
Practice Address - Country:US
Practice Address - Phone:310-531-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2927752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic