=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184771214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVINA KOLLMORGEN & MARIA KATZ PHYSICAL THERAPIST PROF CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5525 ETIWANDA AVE SUITE 110
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-3647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-343-3900
-----------------------------------------------------
Fax | 818-342-8545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5525 ETIWANDA AVE SUITE 110
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-3647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-343-3900
-----------------------------------------------------
Fax | 818-342-8545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PT
-----------------------------------------------------
Name | MRS. SAVINA E KOLLMORGEN
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 818-343-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 22668
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------