Provider Demographics
NPI:1871682062
Name:CANYON PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:CANYON PHYSICAL THERAPY INC.
Other - Org Name:J&M PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:818-886-2005
Mailing Address - Street 1:9545 RESEDA BLVD
Mailing Address - Street 2:#4
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2312
Mailing Address - Country:US
Mailing Address - Phone:818-886-2005
Mailing Address - Fax:
Practice Address - Street 1:9545 RESEDA BLVD
Practice Address - Street 2:#4
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2351
Practice Address - Country:US
Practice Address - Phone:818-886-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8195261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy