Provider Demographics
NPI:1760613871
Name:MARKS, JEFF MORRIS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:MORRIS
Last Name:MARKS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16626 LAUREN WAY
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4830
Mailing Address - Country:US
Mailing Address - Phone:310-251-2808
Mailing Address - Fax:
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2016
Practice Address - Country:US
Practice Address - Phone:818-986-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT16909OtherPHYSICAL THERAPY BOARD OF CALIFORNIA