Healthcare Provider Details

I. General information

NPI: 1609770973
Provider Name (Legal Business Name): NIEA PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22343 MOREA WAY
WOODLAND HILLS CA
91367-7237
US

IV. Provider business mailing address

22343 MOREA WAY
WOODLAND HILLS CA
91367-7237
US

V. Phone/Fax

Practice location:
  • Phone: 424-335-4939
  • Fax:
Mailing address:
  • Phone: 424-335-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MA JOSINA FARREL
Title or Position: OWNER
Credential: PT
Phone: 360-353-1065