Provider Demographics
NPI:1073919346
Name:BDI PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BDI PHYSICAL THERAPY, INC.
Other - Org Name:THE BALANCE DISORDERS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-223-9985
Mailing Address - Street 1:23067 VENTURA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23067 VENTURA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1150
Practice Address - Country:US
Practice Address - Phone:818-223-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty