Healthcare Provider Details

I. General information

NPI: 1417046053
Provider Name (Legal Business Name): NEWBURY PARK PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 CAMINO DOS RIOS STE 406
NEWBURY PARK CA
91320-1156
US

IV. Provider business mailing address

2814 CAMINO DOS RIOS STE 406
NEWBURY PARK CA
91320-1156
US

V. Phone/Fax

Practice location:
  • Phone: 805-375-1461
  • Fax: 805-498-7613
Mailing address:
  • Phone: 805-375-1461
  • Fax: 805-498-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BERNARDINE THOMAS
Title or Position: OWNER
Credential: P.T.
Phone: 805-375-1461