Healthcare Provider Details

I. General information

NPI: 1295882884
Provider Name (Legal Business Name): PEDIATRIC THERAPY OF SANTA CLARITA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26639 VALLEY CENTER DR SUITE 101
SANTA CLARITA CA
91351-2357
US

IV. Provider business mailing address

26639 VALLEY CENTER DR SUITE 101
SANTA CLARITA CA
91351-2357
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-1842
  • Fax: 661-254-1862
Mailing address:
  • Phone: 661-254-1842
  • Fax: 661-254-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT21490
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT21192
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 1285
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR 323
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR5929
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR 2463
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP8235
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP40
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP11852
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6937
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4138
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name: LIZABETH JEAN BUNKELL
Title or Position: PROGRAM DIRECTOR OWNER
Credential:
Phone: 661-254-1842