Provider Demographics
NPI:1689622292
Name:PIERRE, MARC A (PT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:PIERRE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 SANTA MONICA BLVD
Mailing Address - Street 2:STE 470
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4749
Mailing Address - Country:US
Mailing Address - Phone:310-475-6038
Mailing Address - Fax:310-441-5367
Practice Address - Street 1:10780 SANTA MONICA BLVD
Practice Address - Street 2:STE 470
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4749
Practice Address - Country:US
Practice Address - Phone:310-475-6038
Practice Address - Fax:310-441-5367
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00128560OtherBCBS
CAWPT12856AMedicare PIN