Provider Demographics
NPI:1295882884
Name:PEDIATRIC THERAPY OF SANTA CLARITA
Entity type:Organization
Organization Name:PEDIATRIC THERAPY OF SANTA CLARITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZABETH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BUNKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-254-1842
Mailing Address - Street 1:26639 VALLEY CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2357
Mailing Address - Country:US
Mailing Address - Phone:661-254-1842
Mailing Address - Fax:661-254-1862
Practice Address - Street 1:26639 VALLEY CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-2357
Practice Address - Country:US
Practice Address - Phone:661-254-1842
Practice Address - Fax:661-254-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP8235235Z00000X
CAOTR 323225XP0200X
CASLP40235Z00000X
CASLP11852235Z00000X
CAPT214902251P0200X
CAOTR5929225XP0200X
CAOTR 2463225XP0200X
CASLP6937235Z00000X
CASLP4138235Z00000X
CA235Z00000X
CAAT 1285225200000X
CAPT211922251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty