Provider Demographics
NPI:1750301917
Name:REED, MERLE THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:THOMAS
Last Name:REED
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 1:22746 VENTURA BLVD # 358
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1333
Mailing Address - Country:US
Mailing Address - Phone:818-786-9012
Mailing Address - Fax:818-786-5729
Practice Address - Street 1:7232 VAN NUYS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2231
Practice Address - Country:US
Practice Address - Phone:818-786-9012
Practice Address - Fax:818-786-5729
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11474AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAPT11474Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.