Provider Demographics
NPI:1902217409
Name:FORWARD MOTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FORWARD MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT, CSCS
Authorized Official - Phone:747-900-6362
Mailing Address - Street 1:23101 SHERMAN PL STE 515
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2052
Mailing Address - Country:US
Mailing Address - Phone:747-900-6362
Mailing Address - Fax:747-900-6114
Practice Address - Street 1:23101 SHERMAN PL STE 515
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2052
Practice Address - Country:US
Practice Address - Phone:747-900-6362
Practice Address - Fax:747-900-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty