Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shanhat Yacob

Individual provider Physical Medicine & Rehabilitation Physician · NPI 1477404317

Shanhat Yacob is a Physical Therapist in Private Practice in Marina del Rey, California. Qualified in 2023, 3 years ago. Practices with Blake Physical Therapy PC, a 10-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2026

Practice location Address checks out

4820 Lincoln Blvd
Marina del Rey, CA 90292-6917
Phone: (310) 392-7889
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X · Licence 307932 (CA)

Record details

NPI number1477404317
Entity typeIndividual (Type 1)
GenderNot disclosed
Sole proprietorNo
NPI enumeratedFebruary 6, 2026
Last updated in NPPESFebruary 6, 2026
Certification dateFebruary 6, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Blake Physical Therapy Pc — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Marina del Rey