Healthcare Provider Details

I. General information

NPI: 1033297692
Provider Name (Legal Business Name): FREE MOTION THERAPEUTICS & PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2801
US

IV. Provider business mailing address

1115 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2801
US

V. Phone/Fax

Practice location:
  • Phone: 805-306-1840
  • Fax:
Mailing address:
  • Phone: 805-306-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number27754
License Number StateCA

VIII. Authorized Official

Name: MR. PAUL M LEFKO
Title or Position: CEO
Credential: PT
Phone: 805-306-1840