Provider Demographics
NPI:1184200032
Name:ROBERT N METTAM PT AND TIMOTHY P EVERITT PT PHYSICAL THERAPISTS INC
Entity Type:Organization
Organization Name:ROBERT N METTAM PT AND TIMOTHY P EVERITT PT PHYSICAL THERAPISTS INC
Other - Org Name:MPE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:EVERITT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-707-7344
Mailing Address - Street 1:30135 AGOURA RD STE C
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4338
Mailing Address - Country:US
Mailing Address - Phone:818-707-7344
Mailing Address - Fax:
Practice Address - Street 1:30135 AGOURA RD STE C
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4338
Practice Address - Country:US
Practice Address - Phone:818-707-7344
Practice Address - Fax:818-707-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty