=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982751640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENSINGTON PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 NEWBURY RD SUITE 210
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-6435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-358-0215
-----------------------------------------------------
Fax | 805-214-9927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 638 LINDERO CANYON RD # 506
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91377-5457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-358-0215
-----------------------------------------------------
Fax | 805-214-9927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IAN MACAULAY ROBINSON
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 805-358-0215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 15149
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------