Healthcare Provider Details

I. General information

NPI: 1285765685
Provider Name (Legal Business Name): DEEPEN BHATT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24051 NEWHALL RANCH RD
VALENCIA CA
91355-5702
US

IV. Provider business mailing address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-6364
  • Fax: 661-254-6787
Mailing address:
  • Phone: 818-901-6600
  • Fax: 818-997-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT28715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT28715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: