Provider Demographics
NPI:1518025931
Name:AJ PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:AJ PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-986-7266
Mailing Address - Street 1:16573 VENTURA BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2024
Mailing Address - Country:US
Mailing Address - Phone:818-986-7266
Mailing Address - Fax:818-287-6783
Practice Address - Street 1:16573 VENTURA BLVD STE 8
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2024
Practice Address - Country:US
Practice Address - Phone:818-986-7266
Practice Address - Fax:818-287-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-273732251X0800X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66160ZOtherBLUE SHIELD GROUP ID
CA611625900OtherDEPT OF LABOR
CADE2058Medicare ID - Type UnspecifiedMEDICARE RR GROUP ID