Healthcare Provider Details

I. General information

NPI: 1639443690
Provider Name (Legal Business Name): LURIE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17071 VENTURA BLVD SUITE 103
ENCINO CA
91316-4130
US

IV. Provider business mailing address

29139 FOUNTAINWOOD ST
AGOURA HILLS CA
91301-1664
US

V. Phone/Fax

Practice location:
  • Phone: 206-250-3415
  • Fax:
Mailing address:
  • Phone: 206-250-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number37259
License Number StateCA

VIII. Authorized Official

Name: DR. JOSHUA D LURIE
Title or Position: CEO
Credential: DPT
Phone: 818-232-4884