Provider Demographics
NPI:1922311703
Name:PICKETT, RAHEEDAH (DPT)
Entity Type:Individual
Prefix:
First Name:RAHEEDAH
Middle Name:
Last Name:PICKETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2118
Mailing Address - Fax:323-361-8032
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2118
Practice Address - Fax:323-361-8032
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist