Provider Demographics
NPI:1184639593
Name:HYLLENGREN, JANICE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:HYLLENGREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-777-7370
Mailing Address - Fax:805-777-7380
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-777-7370
Practice Address - Fax:805-777-7380
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043236078OtherGROUP NPI #
CA25500OtherPT LICENSE