Provider Demographics
NPI:1942429410
Name:ORTHOTHERAPETUCIS
Entity Type:Organization
Organization Name:ORTHOTHERAPETUCIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANIJEH
Authorized Official - Middle Name:
Authorized Official - Last Name:EZATVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-375-0001
Mailing Address - Street 1:1000 NEWBURY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 NEWBURY RD STE 120
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6437
Practice Address - Country:US
Practice Address - Phone:805-375-0001
Practice Address - Fax:805-375-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty