Provider Demographics
NPI:1073144127
Name:MANAGED CARE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MANAGED CARE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:MOHSENI
Authorized Official - Last Name:KASHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-886-2245
Mailing Address - Street 1:18531 ROSCOE BLVD
Mailing Address - Street 2:SUITE 215A
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18531 ROSCOE BLVD
Practice Address - Street 2:SUITE 215A
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5462
Practice Address - Country:US
Practice Address - Phone:818-886-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy