Provider Demographics
NPI:1043236078
Name:WESTLAKE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:WESTLAKE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T., OWNER. SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:VI
Authorized Official - Credentials:PT
Authorized Official - Phone:805-777-7370
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-777-7370
Mailing Address - Fax:805-777-7380
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-777-7370
Practice Address - Fax:805-777-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15503Medicare ID - Type UnspecifiedMEDICARE GROUP ID