Provider Demographics
NPI:1710282421
Name:TAKEUCHI WANLASS, ISAAC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:TAKEUCHI WANLASS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ISAAC
Other - Middle Name:
Other - Last Name:WANLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3244 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2719
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:310-698-5410
Practice Address - Street 1:15477 VENTURA BLVD
Practice Address - Street 2:200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:818-986-2146
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist