Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 27509 | CA |
NPI | 1003138496 |
---|---|
Provider Name | Shlomit Bercovich |
First Address | Tarzana, CA 91356-3647 |
Second Address | Tarzana, CA 91356-3647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2010 |
Last Update Date | 25/02/2010 |