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DAWN MAE DEGROOT PTA

>> Physical Medicine & Rehabilitation >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1659881167

Individual Registrant:
 DAWN MAE DEGROOT PTA
Gender: F
Not Sole Proprietor

Location and contact information for practice:
8015 S SEPULVEDA BLVD  WESTCHESTER, CA 90045-2940 US
Tel: 310-991-7751  Fax: --

Contact information for business:
537 AVENUE A  REDONDO BEACH, CA 90277-4802 US
Tel: 719-310-4167  Fax: --

Registration Information:
NPI: 1659881167
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N208100000XAllopathic & Osteopathic Physicians
Physical Medicine & Rehabilitation
COPTA0012192
Y208100000XAllopathic & Osteopathic Physicians
Physical Medicine & Rehabilitation
CAPTA48746

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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