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General NPI Number Information
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NPI Number | 1487826889
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Entity Type | Organization
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Legal Business Name | SG MIKITA RPT A PHYSICAL THERAPY CORPORATION
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 10718 WHITE OAK AVE SUITE 2
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City | GRANADA HILLS
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State | CA
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Zip | 91344-4628
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Country | US
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Telephone | 818-368-9484
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Fax | 818-368-8054
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Provider Business Mailing Address
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Address Line | 10718 WHITE OAK AVE SUITE 2
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City | GRANADA HILLS
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State | CA
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Zip | 91344-4628
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Country | US
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Telephone | 818-368-9484
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Fax | 818-368-8054
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRANDON BISHOP
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Credential | DPT
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Telephone | 818-368-9484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 | PT28298
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License Number State | CA
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