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General NPI Number Information
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NPI Number | 1720376403
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Entity Type | Organization
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Legal Business Name | POW PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 4601 TELEPHONE RD SUITE 108
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City | VENTURA
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State | CA
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Zip | 93003-5670
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Country | US
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Telephone | 310-927-0039
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 TELEPHONE RD SUITE 108
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City | VENTURA
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State | CA
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Zip | 93003-5670
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Country | US
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Telephone | 310-927-0039
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | JENNIFER BALLENTINE EVANS
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Credential | PT, DPT, WCS
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Telephone | 310-927-0039
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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 | 33278
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License Number State | CA
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