Basic Information
| Provider Information | |||||||||
| NPI: | 1134758055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIL | ||||||||
| FirstName: | LADY | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S MANHATTAN PL APT 318 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900054131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238681083 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2051 MARENGO ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234091000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2020 | ||||||||
| LastUpdateDate: | 04/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 294642 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.