Provider Demographics
NPI:1720204852
Name:MERIOLES, FERDINAND A (PT, MTC)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:A
Last Name:MERIOLES
Suffix:
Gender:M
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9353 IMPERIAL HWY
Mailing Address - Street 2:PM&R GARDEN MEDICAL OFFICE ( 3RD FLOOR )
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2812
Mailing Address - Country:US
Mailing Address - Phone:562-657-4803
Mailing Address - Fax:
Practice Address - Street 1:9353 IMPERIAL HWY
Practice Address - Street 2:PM&R GARDEN MEDICAL OFFICE ( 3RD FLOOR )
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2812
Practice Address - Country:US
Practice Address - Phone:562-657-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist