Healthcare Provider Details

I. General information

NPI: 1518025931
Provider Name (Legal Business Name): AJ PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16573 VENTURA BLVD STE 8
ENCINO CA
91436-2024
US

IV. Provider business mailing address

16573 VENTURA BLVD STE 8
ENCINO CA
91436-2024
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-7266
  • Fax: 818-287-6783
Mailing address:
  • Phone: 818-986-7266
  • Fax: 818-287-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-27373
License Number StateCA

VIII. Authorized Official

Name: BARAK KRAUS
Title or Position: OWNER
Credential: DPT
Phone: 818-986-7266