Healthcare Provider Details

I. General information

NPI: 1043236078
Provider Name (Legal Business Name): WESTLAKE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LA VENTA DR SUITE 102
WESTLAKE VILLAGE CA
91361-3703
US

IV. Provider business mailing address

1220 LA VENTA DR SUITE 102
WESTLAKE VILLAGE CA
91361-3703
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-7370
  • Fax: 805-777-7380
Mailing address:
  • Phone: 805-777-7370
  • Fax: 805-777-7380

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. ANTHONY CARMEN VASQUEZ VI
Title or Position: P.T., OWNER. SECRETARY/TREASURER
Credential: P.T.
Phone: 805-777-7370