Healthcare Provider Details

I. General information

NPI: 1942429410
Provider Name (Legal Business Name): ORTHOTHERAPETUCIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEWBURY RD STE 120
THOUSAND OAKS CA
91320-6437
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:
  • 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: MANIJEH EZATVAR
Title or Position: CEO
Credential:
Phone: 805-375-0001