Provider Demographics
NPI:1033803168
Name:VICTORY PHYSICAL REHABILITATION, INC
Entity Type:Organization
Organization Name:VICTORY PHYSICAL REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MEYER
Authorized Official - Last Name:KOSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-419-0049
Mailing Address - Street 1:11631 VICTORY BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3572
Mailing Address - Country:US
Mailing Address - Phone:323-645-1871
Mailing Address - Fax:818-764-3032
Practice Address - Street 1:11631 VICTORY BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:323-645-1871
Practice Address - Fax:818-764-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty