Basic Information
| Provider Information | |||||||||
| NPI: | 1003913286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRANADA HILLS PHYSICAL THERAPY & REHAB, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10515 BALBOA BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8183633099 | ||||||||
| Practice Location | |||||||||
| Address1: | 10515 BALBOA BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8183633099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | FERNANDO | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8183633000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT28812 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1801991955 | 01 | CA | NPI | OTHER |