Provider Demographics
NPI:1932363140
Name:SPEER, SASHA MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:MARIE
Last Name:SPEER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 HILLHURST AVE # 156
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2719
Mailing Address - Country:US
Mailing Address - Phone:424-214-9647
Mailing Address - Fax:
Practice Address - Street 1:8929 S SEPULVEDA BLVD STE 412
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3634
Practice Address - Country:US
Practice Address - Phone:310-505-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36334208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808123800Medicaid
ID808123800Medicaid