Provider Demographics
NPI:1922020866
Name:GILLETTE AND ASSOCIATES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GILLETTE AND ASSOCIATES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-340-8858
Mailing Address - Street 1:6325 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2006
Mailing Address - Country:US
Mailing Address - Phone:818-340-8858
Mailing Address - Fax:818-340-1088
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-340-8858
Practice Address - Fax:818-340-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19541Medicare ID - Type UnspecifiedPT