Healthcare Provider Details

I. General information

NPI: 1518616960
Provider Name (Legal Business Name): THE PHYSICAL THERAPY COLLABORATIVE, A CALIFORNIA CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 RIVERSIDE DR STE 208
SHERMAN OAKS CA
91423-2512
US

IV. Provider business mailing address

13320 RIVERSIDE DR STE 208
SHERMAN OAKS CA
91423-2512
US

V. Phone/Fax

Practice location:
  • Phone: 818-405-0800
  • Fax: 818-405-0801
Mailing address:
  • Phone: 818-405-0800
  • Fax: 818-405-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS CHI YEH LIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PT, DPT
Phone: 818-405-0800