Provider Demographics
NPI:1518185131
Name:WRITER, GLORIA (PT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:WRITER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 MAMMOTH AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4155
Mailing Address - Country:US
Mailing Address - Phone:818-832-7446
Mailing Address - Fax:818-832-7249
Practice Address - Street 1:10605 BALBOA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6347
Practice Address - Country:US
Practice Address - Phone:818-832-7272
Practice Address - Fax:818-832-7249
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 1225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist