Healthcare Provider Details

I. General information

NPI: 1114042165
Provider Name (Legal Business Name): ATHLETIC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30837 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

IV. Provider business mailing address

30837 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

V. Phone/Fax

Practice location:
  • Phone: 818-879-2091
  • Fax: 818-879-1656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDPT16701
License Number StateCA

VIII. Authorized Official

Name: STEPHEN CLARK
Title or Position: OWNER
Credential: DPT
Phone: 818-879-2091