Provider Demographics
NPI:1063517191
Name:EISENSTADT, VIVIAN GAYLE (MAPT,OCS)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:GAYLE
Last Name:EISENSTADT
Suffix:
Gender:F
Credentials:MAPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3320
Mailing Address - Country:US
Mailing Address - Phone:310-623-4444
Mailing Address - Fax:310-623-4455
Practice Address - Street 1:8818 SATURN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3320
Practice Address - Country:US
Practice Address - Phone:310-623-4444
Practice Address - Fax:310-623-4455
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT255062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty