Provider Demographics
NPI:1962610790
Name:LUND, REKHA (MPT)
Entity type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:REKHA
Other - Middle Name:
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:15928 VENTURA BLVD
Mailing Address - Street 2:STE 226
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4479
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15928 VENTURA BLVD
Practice Address - Street 2:STE 226
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4479
Practice Address - Country:US
Practice Address - Phone:310-500-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11809171100000X
CAPT24705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC11809OtherSTATE LICENSE
CAPT24705OtherSTATE LICENSE
CAAC11809OtherSTATE LICENSE