Healthcare Provider Details

I. General information

NPI: 1811400948
Provider Name (Legal Business Name): THERACARE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18607 VENTURA BLVD STE 106
TARZANA CA
91356-4156
US

IV. Provider business mailing address

18607 VENTURA BLVD STE 106
TARZANA CA
91356-4156
US

V. Phone/Fax

Practice location:
  • Phone: 818-975-8203
  • Fax: 818-975-8198
Mailing address:
  • Phone: 818-975-8203
  • Fax: 818-975-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY CIPRIANO
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 818-975-8203