Provider Demographics
NPI:1285944678
Name:BERCHENKO, ELENA KRAVETS (RPT)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:KRAVETS
Last Name:BERCHENKO
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 1:5154 DEL MORENO DR.
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2426
Mailing Address - Country:US
Mailing Address - Phone:818-521-5265
Mailing Address - Fax:818-704-3862
Practice Address - Street 1:315 ARDEN AVE
Practice Address - Street 2:STE 21
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1162
Practice Address - Country:US
Practice Address - Phone:818-704-3862
Practice Address - Fax:818-704-3862
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist