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General NPI Number Information
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NPI Number | 1508986233
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Entity Type | Organization
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Legal Business Name | GARY COLLETTO PT
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10605 BALBOA BLVD #240
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6342
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Country | US
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Telephone | 818-366-3935
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Fax | 818-368-9351
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Provider Business Mailing Address
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Address Line | 16692 KNOLLWOOD DR
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City | GRANADA HILLS
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State | CA
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Zip | 91344-2621
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Country | US
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Telephone | 818-366-3935
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Fax | 818-368-9351
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Authorized Official
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Title or Position | PT
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Name | KATHERINE PRENTICE
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Credential | PT
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Telephone | 818-366-3935
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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 | PT7597
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License Number State | CA
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