Provider Demographics
NPI:1831412832
Name:PEAY, CARLA ANNETTE (MPT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ANNETTE
Last Name:PEAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 FAIRVIEW BLVD
Mailing Address - Street 2:#26
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-2357
Mailing Address - Country:US
Mailing Address - Phone:310-403-1038
Mailing Address - Fax:
Practice Address - Street 1:7188 W SUNSET BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4400
Practice Address - Country:US
Practice Address - Phone:323-436-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist