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General NPI Number Information
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NPI Number | 1871682062
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Entity Type | Organization
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Legal Business Name | CANYON PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 9545 RESEDA BLVD #4
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2351
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Country | US
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Telephone | 818-886-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 9545 RESEDA BLVD #4
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2312
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Country | US
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Telephone | 818-886-2005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFERY HOOPER
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Credential | RPT
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Telephone | 818-886-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT8195
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License Number State | CA
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