Provider Demographics
NPI: | 1396024642 |
---|---|
Name: | PHYSICAL THERAPY FOR SPECIALTY CARE |
Entity Type: | Organization |
Organization Name: | PHYSICAL THERAPY FOR SPECIALTY CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BONNIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CARDENAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 818-308-8747 |
Mailing Address - Street 1: | 12660 RIVERSIDE DR |
Mailing Address - Street 2: | #215 |
Mailing Address - City: | VALLEY VILLAGE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91607-3429 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 818-308-8747 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12660 RIVERSIDE DR |
Practice Address - Street 2: | #215 |
Practice Address - City: | VALLEY VILLAGE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91607-3429 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-308-8747 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-08-04 |
Last Update Date: | 2011-08-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |