Provider Demographics
NPI:1740716083
Name:PHYSICAL THERAPY SPECIALISTS
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-363-0339
Mailing Address - Street 1:10515 BALBOA BLVD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-363-0339
Mailing Address - Fax:818-363-9915
Practice Address - Street 1:10515 BALBOA BLVD.
Practice Address - Street 2:SUITE 140
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:818-363-0339
Practice Address - Fax:818-363-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15818225100000X
CAPT9721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty