Provider Demographics
NPI:1639443690
Name:LURIE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LURIE PHYSICAL THERAPY PC
Other - Org Name:BALANCE & VESTIBULAR CENTER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-232-4884
Mailing Address - Street 1:29139 FOUNTAINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1664
Mailing Address - Country:US
Mailing Address - Phone:206-250-3415
Mailing Address - Fax:
Practice Address - Street 1:17071 VENTURA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4130
Practice Address - Country:US
Practice Address - Phone:206-250-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37259261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGG413AOtherMEDICARE PTAN