Provider Demographics
NPI:1891145108
Name:SOUTH PACIFIC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SOUTH PACIFIC PHYSICAL THERAPY INC
Other - Org Name:C/O DOREEN AKRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-907-0952
Mailing Address - Street 1:16161 VENTURA BLVD
Mailing Address - Street 2:# C564
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2522
Mailing Address - Country:US
Mailing Address - Phone:818-907-0952
Mailing Address - Fax:
Practice Address - Street 1:4940 VAN NUYS BLVD
Practice Address - Street 2:#301
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-907-0952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty