Healthcare Provider Details

I. General information

NPI: 1255168357
Provider Name (Legal Business Name): ACTIVIA PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10324 BALBOA BLVD STE 101
GRANADA HILLS CA
91344-7349
US

IV. Provider business mailing address

10324 BALBOA BLVD STE 101
GRANADA HILLS CA
91344-7349
US

V. Phone/Fax

Practice location:
  • Phone: 424-344-4474
  • Fax: 818-279-2804
Mailing address:
  • Phone: 424-344-4474
  • Fax: 818-279-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA AGHAJANYAN
Title or Position: CEO
Credential:
Phone: 818-458-1500