Provider Demographics
NPI:1023456829
Name:DIRSTINE, DARLENE (DPT, NCS)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:
Last Name:DIRSTINE
Suffix:
Gender:F
Credentials:DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:SUITE B #425
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 PIER AVE
Practice Address - Street 2:SUITE B #425
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:917-837-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40030225100000X
FL26567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist