Provider Demographics
NPI:1780808550
Name:PHYSICAL THERAPY & SPORT INJURY REHABILITATION CENTER OF ENCINO
Entity type:Organization
Organization Name:PHYSICAL THERAPY & SPORT INJURY REHABILITATION CENTER OF ENCINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SARCHAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:818-789-4465
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 955
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-789-4465
Mailing Address - Fax:818-789-0279
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 955
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-789-4465
Practice Address - Fax:818-789-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164547741OtherINDIVIDUAL NPI NUMBER
CA1164547741OtherINDIVIDUAL NPI NUMBER
CAPT10218Medicare UPIN