Healthcare Provider Details

I. General information

NPI: 1851523617
Provider Name (Legal Business Name): ATHLETIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 LYNN RD SUITE 250
THOUSAND OAKS CA
91360-1901
US

IV. Provider business mailing address

30877 THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-1485
  • Fax:
Mailing address:
  • Phone: 818-879-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN CLARK
Title or Position: PRESIDENT
Credential: DPT
Phone: 818-340-2002