Healthcare Provider Details

I. General information

NPI: 1396997557
Provider Name (Legal Business Name): J. V. THERAPY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 VAN NUYS BLVD 107
PACOIMA CA
91331-1321
US

IV. Provider business mailing address

12502 VAN NUYS BLVD 104
PACOIMA CA
91331-1321
US

V. Phone/Fax

Practice location:
  • Phone: 818-899-5555
  • Fax: 818-899-5969
Mailing address:
  • Phone: 818-899-5555
  • Fax: 818-899-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0203060
License Number StateCA

VIII. Authorized Official

Name: JENNIFER VIVANCO
Title or Position: DIRECTOR
Credential: P.T.
Phone: 818-899-5555