Provider Demographics
NPI:1730307760
Name:NILES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NILES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-395-3953
Mailing Address - Street 1:3940 LAUREL CANYON BLVD
Mailing Address - Street 2:NO. 254
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3709
Mailing Address - Country:US
Mailing Address - Phone:818-395-3953
Mailing Address - Fax:
Practice Address - Street 1:3959 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4921
Practice Address - Country:US
Practice Address - Phone:818-395-3953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15840Medicare PIN