Provider Demographics
NPI:1922476894
Name:SPIRTOS, PENNIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PENNIE
Middle Name:
Last Name:SPIRTOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 MOUNT ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1333
Mailing Address - Country:US
Mailing Address - Phone:626-294-0070
Mailing Address - Fax:626-294-0080
Practice Address - Street 1:253 N SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3114
Practice Address - Country:US
Practice Address - Phone:626-294-0070
Practice Address - Fax:626-294-0080
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist