Provider Demographics
NPI:1205168713
Name:KEROLS, THABET YOSRY (PSC)
Entity type:Individual
Prefix:
First Name:THABET
Middle Name:YOSRY
Last Name:KEROLS
Suffix:
Gender:M
Credentials:PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E LEXINGTON DR APT 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3642
Mailing Address - Country:US
Mailing Address - Phone:818-913-1583
Mailing Address - Fax:
Practice Address - Street 1:1313 W 8TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4422
Practice Address - Country:US
Practice Address - Phone:213-401-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8918225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant