1497770226 NPI number — ELIZABETH MARY POPPERT D.P.T., M.S., O.C.S.

Table of content: ELIZABETH MARY POPPERT D.P.T., M.S., O.C.S. (NPI 1497770226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497770226 NPI number — ELIZABETH MARY POPPERT D.P.T., M.S., O.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POPPERT
Provider First Name:
ELIZABETH
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T., M.S., O.C.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497770226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1018 EUCLID ST
Provider Second Line Business Mailing Address:
APT 102
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-266-8481
Provider Business Mailing Address Fax Number:
310-315-9349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 OCEAN PARK BLVD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90405-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-913-8480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT21958 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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