Provider Demographics
NPI:1720376403
Name:POW PHYSICAL THERAPY
Entity Type:Organization
Organization Name:POW PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BALLENTINE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, WCS
Authorized Official - Phone:310-927-0039
Mailing Address - Street 1:4601 TELEPHONE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5670
Mailing Address - Country:US
Mailing Address - Phone:310-927-0039
Mailing Address - Fax:
Practice Address - Street 1:4601 TELEPHONE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5670
Practice Address - Country:US
Practice Address - Phone:310-927-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty