Provider Demographics
NPI:1255168357
Name:ACTIVIA PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:ACTIVIA PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHAJANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-458-1500
Mailing Address - Street 1:10324 BALBOA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7349
Mailing Address - Country:US
Mailing Address - Phone:424-344-4474
Mailing Address - Fax:818-279-2804
Practice Address - Street 1:10324 BALBOA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7349
Practice Address - Country:US
Practice Address - Phone:424-344-4474
Practice Address - Fax:818-279-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-14
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty