Provider Demographics
NPI:1053343517
Name:POUILLOUX, PHILIPPE (PT)
Entity type:Individual
Prefix:MR
First Name:PHILIPPE
Middle Name:
Last Name:POUILLOUX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4703
Mailing Address - Country:US
Mailing Address - Phone:310-247-9070
Mailing Address - Fax:310-247-9008
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4703
Practice Address - Country:US
Practice Address - Phone:310-247-9070
Practice Address - Fax:310-247-9008
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist