Provider Demographics
NPI:1467813105
Name:GAMA, MARIANA COUTO (DPT)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:COUTO
Last Name:GAMA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N FIRST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1845
Mailing Address - Country:US
Mailing Address - Phone:818-846-7100
Mailing Address - Fax:818-846-7101
Practice Address - Street 1:100 N FIRST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1845
Practice Address - Country:US
Practice Address - Phone:818-846-7100
Practice Address - Fax:818-846-7101
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist