=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366895492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWEL PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2016
-----------------------------------------------------
Last Update Date | 07/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8349 RESEDA BLVD UNIT F
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-341-3791
-----------------------------------------------------
Fax | 818-341-3794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8349 RESEDA BLVD UNIT F
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-341-3791
-----------------------------------------------------
Fax | 818-341-3794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEWEL T GARCIA
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 818-341-3791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT32907
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------