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General NPI Number Information
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NPI Number | 1447534300
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Entity Type | Individual
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Provider Name | BETH JO PHILLIPS PT, DPA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | KLOTZ STUDENT HEALTH CTR 18111 NORDHOFF STREET
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City | NORTHRIDGE
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State | CA
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Zip | 91330-0001
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Country | US
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Telephone | 818-677-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 4427 VANTAGE AVENUE
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City | STUDIO CITY
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State | CA
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Zip | 91604
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Country | US
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Telephone | 818-677-2203
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Fax | 818-677-7411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT21598
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License Number State | CA
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