Provider Demographics
NPI:1073685079
Name:CORE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-494-3131
Mailing Address - Street 1:31225 LA BAYA DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4019
Mailing Address - Country:US
Mailing Address - Phone:805-494-3131
Mailing Address - Fax:805-494-3002
Practice Address - Street 1:31225 LA BAYA DR
Practice Address - Street 2:SUITE 206
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4019
Practice Address - Country:US
Practice Address - Phone:805-494-3131
Practice Address - Fax:805-494-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18484Medicare PIN