Provider Demographics
NPI:1780089169
Name:PINTO, KEREN MICHELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:MICHELLE
Last Name:PINTO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18344 CLARK ST
Mailing Address - Street 2:#208
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3505
Mailing Address - Country:US
Mailing Address - Phone:818-996-8386
Mailing Address - Fax:818-996-8979
Practice Address - Street 1:19724 KITTRIDGE ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-4327
Practice Address - Country:US
Practice Address - Phone:818-424-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT41632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist