=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114981925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHO THERAPEUTICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2006
-----------------------------------------------------
Last Update Date | 01/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 NEWBURY RD SUITE # 120
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-375-0001
-----------------------------------------------------
Fax | 805-375-2221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 NEWBURY RD STE 120
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-6437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-375-0001
-----------------------------------------------------
Fax | 805-375-2221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTER PHYSICAL THERAPIST
-----------------------------------------------------
Name | CARLOS G. BRAIN
-----------------------------------------------------
Credential | RPT
-----------------------------------------------------
Telephone | 805-375-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 19200
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------