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General NPI Number Information
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NPI Number | 1760148514
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Entity Type | Organization
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Legal Business Name | ARSENAL ORTHOPAEDIC AND SPORT PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 1090 LAWRENCE DR STE 101
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-1315
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Country | US
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Telephone | 805-402-2949
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Fax |
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Provider Business Mailing Address
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Address Line | 13195 KNOTTY PINE ST
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City | MOORPARK
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State | CA
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Zip | 93021-2161
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Country | US
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Telephone | 805-402-2949
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, TREASURER, SECRETARY
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Name | JUSTIN BROUHARD
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Credential | DPT
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Telephone | 805-402-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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