Provider Demographics
NPI:1518040278
Name:POWERS, DAVID VINCENT (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VINCENT
Last Name:POWERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1583 CALLE PATRICIA
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1942
Mailing Address - Country:US
Mailing Address - Phone:310-454-4678
Mailing Address - Fax:310-454-5049
Practice Address - Street 1:881 ALMA REAL DR STE 211
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3748
Practice Address - Country:US
Practice Address - Phone:310-454-0060
Practice Address - Fax:310-454-0065
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT8927BMedicare PIN