Provider Demographics
NPI:1043572217
Name:JBP PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:JBP PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAINA
Authorized Official - Middle Name:BHAGAT
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:415-238-6470
Mailing Address - Street 1:9545 RESEDA BLVD
Mailing Address - Street 2:UNIT 3,4
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:415-238-6470
Mailing Address - Fax:
Practice Address - Street 1:9545 RESEDA BLVD
Practice Address - Street 2:UNIT 3,4
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2312
Practice Address - Country:US
Practice Address - Phone:415-238-6470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36869261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy