Healthcare Provider Details

I. General information

NPI: 1447079785
Provider Name (Legal Business Name): CORE ELEMENT PHYSICAL THERAPY AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CARMEN DR
CAMARILLO CA
93010-6033
US

IV. Provider business mailing address

5062 CREEKSIDE RD
CAMARILLO CA
93012-5303
US

V. Phone/Fax

Practice location:
  • Phone: 818-261-0567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA MATALON
Title or Position: CEO
Credential: PT, DPT
Phone: 818-261-0567