Basic Information
| Provider Information | |||||||||
| NPI: | 1003013251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEROCK | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15248 DICKENS STREET | ||||||||
| Address2: | UNIT 108 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189060603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 335 N LA BREA STREET | ||||||||
| Address2: | BOB HOPE MEDICAL CLINIC | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236343826 | ||||||||
| FaxNumber: | 3239389958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT9290 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.