Provider Demographics
NPI:1447681622
Name:VINCE, ELEONORA (DPT)
Entity type:Individual
Prefix:DR
First Name:ELEONORA
Middle Name:
Last Name:VINCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LAS VIRGENES CANYON RD.
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302
Mailing Address - Country:US
Mailing Address - Phone:818-880-4758
Mailing Address - Fax:818-880-4781
Practice Address - Street 1:4505 LAS VIRGENES CANYON RD.
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-880-4758
Practice Address - Fax:818-880-4781
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist