Provider Demographics
NPI:1598770349
Name:ANTELOPE VALLEY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ANTELOPE VALLEY PHYSICAL THERAPY, INC.
Other - Org Name:RANCHO WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:CENA
Authorized Official - Last Name:VODANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:661-266-9578
Mailing Address - Street 1:42135 10TH ST W STE 147
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-6093
Mailing Address - Country:US
Mailing Address - Phone:661-266-9578
Mailing Address - Fax:661-266-2208
Practice Address - Street 1:42135 10TH ST W STE 147
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6093
Practice Address - Country:US
Practice Address - Phone:661-266-9578
Practice Address - Fax:661-266-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15100Medicare PIN