Provider Demographics
NPI:1245370188
Name:KERVIN, EWELINA (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:EWELINA
Middle Name:
Last Name:KERVIN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:EWELINA
Other - Middle Name:
Other - Last Name:WOSIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2615 PACIFIC COAST HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2285
Mailing Address - Country:US
Mailing Address - Phone:310-933-3690
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY STE 120
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2285
Practice Address - Country:US
Practice Address - Phone:310-933-3690
Practice Address - Fax:310-798-6312
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007804A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist