Provider Demographics
NPI:1265665772
Name:NORTH VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NORTH VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAZIMIR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-468-7068
Mailing Address - Street 1:11858 1/2 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2762
Mailing Address - Country:US
Mailing Address - Phone:818-468-7068
Mailing Address - Fax:818-368-0455
Practice Address - Street 1:11858 1/2 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2762
Practice Address - Country:US
Practice Address - Phone:818-468-7068
Practice Address - Fax:818-368-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13354261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy