Provider Demographics
NPI:1952455461
Name:DATE, JANICE Y (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:Y
Last Name:DATE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11835 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 135E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5001
Mailing Address - Country:US
Mailing Address - Phone:310-401-6410
Mailing Address - Fax:310-312-3637
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 135E
Practice Address - Street 2:SUITE 135E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5047
Practice Address - Country:US
Practice Address - Phone:310-401-6410
Practice Address - Fax:310-312-3637
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist