Provider Demographics
NPI:1497770226
Name:POPPERT, ELIZABETH MARY (DPT, MS, OCS)
Entity Type:Individual
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First Name:ELIZABETH
Middle Name:MARY
Last Name:POPPERT
Suffix:
Gender:F
Credentials:DPT, MS, OCS
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Mailing Address - Street 1:1018 EUCLID ST
Mailing Address - Street 2:APT 102
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4231
Mailing Address - Country:US
Mailing Address - Phone:310-266-8481
Mailing Address - Fax:310-315-9349
Practice Address - Street 1:2601 OCEAN PARK BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5215
Practice Address - Country:US
Practice Address - Phone:310-913-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PT21958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT21958Medicare ID - Type Unspecified