Provider Demographics
NPI:1144081902
Name:POLIKAITIS, ANDRIUS (DPT)
Entity type:Individual
Prefix:
First Name:ANDRIUS
Middle Name:
Last Name:POLIKAITIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 ETTRICK ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2501
Mailing Address - Country:US
Mailing Address - Phone:661-607-2290
Mailing Address - Fax:
Practice Address - Street 1:1020 MISSION ST UNIT A
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3172
Practice Address - Country:US
Practice Address - Phone:714-557-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist