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General NPI Number Information
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NPI Number | 1558498337
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Entity Type | Organization
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Legal Business Name | WESTLAKE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 110 JENSEN CT SUITE 2C
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7483
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Country | US
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Telephone | 805-413-1070
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Fax | 805-413-1076
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Provider Business Mailing Address
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Address Line | 1220 LA VENTA DR SUITE 102
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3703
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Country | US
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Telephone | 805-777-7370
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Fax | 805-777-7380
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Authorized Official
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Title or Position | P.T., OWNER, SECRETARY & TREASURER
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Name | MR. ANTHONY CARMEN VASQUEZ
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Credential | P.T.
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Telephone | 805-777-7370
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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 |
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License Number State |
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