Provider Demographics
NPI:1538943162
Name:MAIMONE, URIAH JOSEPH (PT)
Entity type:Individual
Prefix:DR
First Name:URIAH
Middle Name:JOSEPH
Last Name:MAIMONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CALLE MAYOR
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6509
Mailing Address - Country:US
Mailing Address - Phone:310-704-7177
Mailing Address - Fax:
Practice Address - Street 1:550 DEEP VALLEY DR STE 297
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3698
Practice Address - Country:US
Practice Address - Phone:310-544-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist