Provider Demographics
NPI:1760537989
Name:PADILLA, MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E. AMAR ROAD
Mailing Address - Street 2:#120
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1717
Mailing Address - Country:US
Mailing Address - Phone:626-667-7306
Mailing Address - Fax:626-667-7306
Practice Address - Street 1:1901 E. AMAR ROAD
Practice Address - Street 2:#120
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1717
Practice Address - Country:US
Practice Address - Phone:626-667-7306
Practice Address - Fax:626-667-7306
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8043225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant