Provider Demographics
NPI:1831866722
Name:MAGNOLIA OAKS PHYSICAL THERAPY APC
Entity type:Organization
Organization Name:MAGNOLIA OAKS PHYSICAL THERAPY APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIEBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-789-3819
Mailing Address - Street 1:PO BOX 55635
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-0635
Mailing Address - Country:US
Mailing Address - Phone:818-789-3819
Mailing Address - Fax:818-789-3546
Practice Address - Street 1:14116 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1119
Practice Address - Country:US
Practice Address - Phone:818-789-3819
Practice Address - Fax:818-789-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty