Provider Demographics
NPI:1619998101
Name:MORI, ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:MORI
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 1:650 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3429
Mailing Address - Country:US
Mailing Address - Phone:818-952-0906
Mailing Address - Fax:818-952-0906
Practice Address - Street 1:650 FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3429
Practice Address - Country:US
Practice Address - Phone:818-952-0906
Practice Address - Fax:818-952-0906
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10483OtherPHYSICAL THERAPY
CAPT10483Medicare ID - Type UnspecifiedPHYSICAL THERAPY