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General NPI Number Information
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NPI Number | 1245834381
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Entity Type | Organization
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Legal Business Name | DSTRKT LLC
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 19851 NORDHOFF PL STE 104
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City | CHATSWORTH
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State | CA
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Zip | 91311-6616
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Country | US
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Telephone | 818-245-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 19851 NORDHOFF PL STE 104
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City | CHATSWORTH
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State | CA
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Zip | 91311-6616
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Country | US
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Telephone | 818-245-5008
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. ROY PARAS
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Credential | BS, CPT, USATF, CPMT
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Telephone | 818-245-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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