Provider Demographics
NPI:1245834381
Name:DSTRKT LLC
Entity type:Organization
Organization Name:DSTRKT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CPT, USATF, CPMT
Authorized Official - Phone:818-245-5008
Mailing Address - Street 1:19851 NORDHOFF PL STE 104
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6616
Mailing Address - Country:US
Mailing Address - Phone:818-245-5008
Mailing Address - Fax:
Practice Address - Street 1:19851 NORDHOFF PL STE 104
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6616
Practice Address - Country:US
Practice Address - Phone:818-245-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center