Basic Information
| Provider Information | |||||||||
| NPI: | 1801235759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY WEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21781 VENTURA BLVD | ||||||||
| Address2: | #438 | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913641835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182572572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44303 LOWTREE AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619405494 | ||||||||
| FaxNumber: | 6619400825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2013 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | PETERS | ||||||||
| AuthorizedOfficialFirstName: | YARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8182572572 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.