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2001 S Barrington Ave Ste 110, Los Angeles, CA 90025-5337 | |
(310) 453-8668 | |
(310) 453-8662 |
Full Name | |
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Type | Facility |
Speciality | Physical Therapist |
Location | 2001 S Barrington Ave Ste 110, Los Angeles, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356367874 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
171100000X | Acupuncturist | (California) | Secondary |
225100000X | Physical Therapist | (California) | Primary |
Provider Name | Derek Plonka |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1912172438 PECOS PAC ID: 1355387887 Enrollment ID: I20050725000245 |
Mailing Address | Practice Location Address |
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2001 S Barrington Ave Ste 110, Los Angeles, CA 90025-5337 Ph: (310) 453-8668 | 2001 S Barrington Ave Ste 110, Los Angeles, CA 90025-5337 Ph: (310) 453-8668 |