Provider Demographics
NPI:1447219035
Name:PROKOPETS, ANATOLIY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ANATOLIY
Middle Name:
Last Name:PROKOPETS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N LA BREA AVE
Mailing Address - Street 2:APT. 20
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-8318
Mailing Address - Country:US
Mailing Address - Phone:323-377-4691
Mailing Address - Fax:323-874-3727
Practice Address - Street 1:16108 PARTHENIA ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-4808
Practice Address - Country:US
Practice Address - Phone:818-481-2373
Practice Address - Fax:818-830-4188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15382Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER