Provider Demographics
NPI:1528162807
Name:ROSENBERG, MARY KLEMER (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KLEMER
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KLEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7080 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 815
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:323-957-9571
Mailing Address - Fax:323-957-9583
Practice Address - Street 1:7080 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 815
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:323-957-9571
Practice Address - Fax:323-957-9583
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT8435AOtherMEDICARE PTAN#