Provider Demographics
NPI:1417046053
Name:NEWBURY PARK PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:NEWBURY PARK PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-375-1461
Mailing Address - Street 1:2814 CAMINO DOS RIOS STE 406
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1156
Mailing Address - Country:US
Mailing Address - Phone:805-375-1461
Mailing Address - Fax:805-498-7613
Practice Address - Street 1:2814 CAMINO DOS RIOS STE 406
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1156
Practice Address - Country:US
Practice Address - Phone:805-375-1461
Practice Address - Fax:805-498-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15558Medicare ID - Type Unspecified