Provider Demographics
NPI:1720199664
Name:MARMUR, ELI E (MA, RPT)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:E
Last Name:MARMUR
Suffix:
Gender:M
Credentials:MA, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S BEVERLY DR
Mailing Address - Street 2:515
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1148
Mailing Address - Country:US
Mailing Address - Phone:310-277-8882
Mailing Address - Fax:
Practice Address - Street 1:1125 S BEVERLY DR
Practice Address - Street 2:515
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1148
Practice Address - Country:US
Practice Address - Phone:310-277-8882
Practice Address - Fax:310-277-8935
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist