Provider Demographics
NPI:1528140027
Name:DEAIBES, MARCELLE (RPT)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:DEAIBES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10843 MAGNOLIA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3922
Mailing Address - Country:US
Mailing Address - Phone:818-506-4119
Mailing Address - Fax:818-506-8115
Practice Address - Street 1:10843 MAGNOLIA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3922
Practice Address - Country:US
Practice Address - Phone:818-506-4119
Practice Address - Fax:818-506-8115
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16446Medicare ID - Type UnspecifiedPHYSICAL THERAPY