Provider Demographics
NPI:1699386391
Name:PHYSICALI LLC
Entity Type:Organization
Organization Name:PHYSICALI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC-OLIVIER
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:FOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-926-6798
Mailing Address - Street 1:8650 TYRONE AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3118
Mailing Address - Country:US
Mailing Address - Phone:310-926-6798
Mailing Address - Fax:
Practice Address - Street 1:8650 TYRONE AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3118
Practice Address - Country:US
Practice Address - Phone:310-926-6798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health