Provider Demographics
NPI:1790995801
Name:NILES, GAIL (PT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:NILES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 LAUREL CANYON BLVD
Mailing Address - Street 2:UNIT 254
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3709
Mailing Address - Country:US
Mailing Address - Phone:818-395-3953
Mailing Address - Fax:
Practice Address - Street 1:3959 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4921
Practice Address - Country:US
Practice Address - Phone:818-395-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist