Provider Demographics
NPI:1689380263
Name:FERREIRA XANTHAKIS, RENATA (PT)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:FERREIRA XANTHAKIS
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 1:2601 AIRPORT DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6132
Mailing Address - Country:US
Mailing Address - Phone:310-751-0635
Mailing Address - Fax:
Practice Address - Street 1:2601 AIRPORT DR STE 120
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6132
Practice Address - Country:US
Practice Address - Phone:310-751-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38160225100000X
CA303549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist