Provider Demographics
NPI:1720506017
Name:DEVERS, JAMIL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:
Last Name:DEVERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JAMIL
Other - Middle Name:
Other - Last Name:NOGUERA-DEVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6801 PARK TERRACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:310-665-7100
Mailing Address - Fax:
Practice Address - Street 1:6801 PARK TERRACE DRIVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-665-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist