Provider Demographics
NPI:1023014941
Name:RESTORATIVE ARTS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RESTORATIVE ARTS PHYSICAL THERAPY INC
Other - Org Name:CORE CONDITIONING
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-907-0008
Mailing Address - Street 1:12930 VENTURA BLVD
Mailing Address - Street 2:STE 226A
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2200
Mailing Address - Country:US
Mailing Address - Phone:818-907-0008
Mailing Address - Fax:818-907-0088
Practice Address - Street 1:12930 VENTURA BLVD
Practice Address - Street 2:STE 226A
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2200
Practice Address - Country:US
Practice Address - Phone:818-907-0008
Practice Address - Fax:818-907-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18517302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17175Medicare ID - Type Unspecified