Healthcare Provider Details

I. General information

NPI: 1114981925
Provider Name (Legal Business Name): ORTHO THERAPEUTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD SUITE # 120
THOUSAND OAKS CA
91320-3613
US

IV. Provider business mailing address

1000 NEWBURY RD STE 120
THOUSAND OAKS CA
91320-6437
US

V. Phone/Fax

Practice location:
  • Phone: 805-375-0001
  • Fax: 805-375-2221
Mailing address:
  • Phone: 805-375-0001
  • Fax: 805-375-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19200
License Number StateCA

VIII. Authorized Official

Name: CARLOS G. BRAIN
Title or Position: REGISTER PHYSICAL THERAPIST
Credential: RPT
Phone: 805-375-0001