Basic Information
| Provider Information | |||||||||
| NPI: | 1528077559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOHDES | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 W. 5TH STREET | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907323418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105489748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3250 LOMITA BOULEVARD | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105398800 | ||||||||
| FaxNumber: | 3106985414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| 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 | 225200000X | AT 1965 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.