Healthcare Provider Details

I. General information

NPI: 1538834643
Provider Name (Legal Business Name): THERAPY INNOVATIONS PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 RIDGEBROOK PL
THOUSAND OAKS CA
91362-5315
US

IV. Provider business mailing address

2473 RIDGEBROOK PL
THOUSAND OAKS CA
91362-5315
US

V. Phone/Fax

Practice location:
  • Phone: 805-402-7230
  • Fax:
Mailing address:
  • Phone: 805-402-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL SHAPIRO
Title or Position: CEO
Credential: PT
Phone: 805-402-7230