Provider Demographics
NPI:1457417487
Name:LONTOC, LOUISE (PT)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:LONTOC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:
Other - Last Name:CADIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:3901 HOWARD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3633
Mailing Address - Country:US
Mailing Address - Phone:562-346-7976
Mailing Address - Fax:
Practice Address - Street 1:8615 KNOTT AVE STE 8
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3892
Practice Address - Country:US
Practice Address - Phone:714-527-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist