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General NPI Number Information
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NPI Number | 1497771885
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Entity Type | Organization
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Legal Business Name | PATRICK PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 14301 VENTURA BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2716
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Country | US
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Telephone | 818-995-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 14301 VENTURA BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2716
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Country | US
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Telephone | 818-995-0918
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RHETT SHANNON PATRICK
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Credential | MPT
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Telephone | 818-995-0918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT24157
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License Number State | CA
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