MEDICARE: KASABOVS PHYSICAL THERAPY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1285907527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KASABOVS PHYSICAL THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	18411 COLLINS ST
Second Line	:	UNIT B
City	:	TARZANA
State	:	CA
Zip	:	91356-2370
Country	:	US
Telephone Number	:	818-571-6095
Fax Number	:	818-881-0258

Provider Business Practice Location Address
First Line	:	45 ERBES RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-5802
Country	:	US
Telephone Number	:	805-495-4657
Fax Number	:	818-881-0258

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	IRINA KASABOV
Credential	:	PT
Telephone Number	:	805-495-4657

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	04/28/2012

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