| NPI | 1851734057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN THEIS Partner 818-344-8378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA PT24176) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2022-12-15 |