Provider Demographics
NPI:1023153236
Name:WESTLAKE SPORTS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:WESTLAKE SPORTS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RANIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-371-9116
Mailing Address - Street 1:4165 E THOUSAND OAKS BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3837
Mailing Address - Country:US
Mailing Address - Phone:805-371-9116
Mailing Address - Fax:
Practice Address - Street 1:4165 E THOUSAND OAKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3837
Practice Address - Country:US
Practice Address - Phone:805-371-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA296942OtherPT LICENSE