Healthcare Provider Details

I. General information

NPI: 1104641463
Provider Name (Legal Business Name): A5 PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29219 CANWOOD ST UNIT 107
AGOURA HILLS CA
91301-1560
US

IV. Provider business mailing address

1305 WOODLOW CT
WESTLAKE VILLAGE CA
91361-1756
US

V. Phone/Fax

Practice location:
  • Phone: 818-914-7559
  • Fax: 818-914-7560
Mailing address:
  • Phone: 617-605-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AJIT SANKHE
Title or Position: CFO
Credential: DPT
Phone: 617-605-0295