Provider Demographics
NPI:1811332661
Name:SKYLINE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:SKYLINE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-831-2400
Mailing Address - Street 1:16219 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6910
Mailing Address - Country:US
Mailing Address - Phone:818-831-2400
Mailing Address - Fax:818-831-2411
Practice Address - Street 1:16223 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6910
Practice Address - Country:US
Practice Address - Phone:818-831-2400
Practice Address - Fax:818-831-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty