Provider Demographics
NPI:1760148514
Name:ARSENAL ORTHOPAEDIC AND SPORT PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:ARSENAL ORTHOPAEDIC AND SPORT PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, TREASURER, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-402-2949
Mailing Address - Street 1:13195 KNOTTY PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2161
Mailing Address - Country:US
Mailing Address - Phone:805-402-2949
Mailing Address - Fax:
Practice Address - Street 1:1090 LAWRENCE DR STE 101
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1315
Practice Address - Country:US
Practice Address - Phone:805-402-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty