Healthcare Provider Details

I. General information

NPI: 1003913286
Provider Name (Legal Business Name): GRANADA HILLS PHYSICAL THERAPY & REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 BALBOA BLVD SUITE 140
GRANADA HILLS CA
91344-6343
US

IV. Provider business mailing address

10515 BALBOA BLVD SUITE 140
GRANADA HILLS CA
91344-6343
US

V. Phone/Fax

Practice location:
  • Phone: 818-363-3000
  • Fax: 818-363-3099
Mailing address:
  • Phone: 818-363-3000
  • Fax: 818-363-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT28812
License Number StateCA

VIII. Authorized Official

Name: LUIS FERNANDO RODRIGUEZ
Title or Position: CFO
Credential:
Phone: 818-363-3000