Provider Demographics
NPI:1417132424
Name:HERMENS, MARCUS A (RPT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:A
Last Name:HERMENS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 STALWART DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6025
Mailing Address - Country:US
Mailing Address - Phone:310-418-6769
Mailing Address - Fax:310-544-0803
Practice Address - Street 1:1611 HEIGHT ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-2840
Practice Address - Country:US
Practice Address - Phone:661-872-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163622251G0304X
2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics