Provider Demographics
NPI:1639217508
Name:BRAIN INJURY SPECIALISTS-PHYSICAL INJURY SPECIALISTS INC.
Entity Type:Organization
Organization Name:BRAIN INJURY SPECIALISTS-PHYSICAL INJURY SPECIALISTS INC.
Other - Org Name:PHYSICAL INJURY SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VINCELETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:805-643-0123
Mailing Address - Street 1:1746F S VICTORIA AVE # 356
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6592
Mailing Address - Country:US
Mailing Address - Phone:805-643-0123
Mailing Address - Fax:805-643-0114
Practice Address - Street 1:66 ENCINAL PL
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3316
Practice Address - Country:US
Practice Address - Phone:805-643-0123
Practice Address - Fax:805-643-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty