Provider Demographics
NPI:1720163967
Name:NORTHRANCH WELLNESS, INC
Entity Type:Organization
Organization Name:NORTHRANCH WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-889-8373
Mailing Address - Street 1:31225 LA BAYA DR STE 206B
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4019
Mailing Address - Country:US
Mailing Address - Phone:818-889-8373
Mailing Address - Fax:818-889-7368
Practice Address - Street 1:31225 LA BAYA DR STE 206B
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4019
Practice Address - Country:US
Practice Address - Phone:818-889-8373
Practice Address - Fax:818-889-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19320Medicare UPIN