1225689623 NPI number — PLYOKINETICS THERAPY INC - A PHYSICAL THERAPY CORPORATION

Table of content: DR. JOSHUA MICHAEL BUCKLER M.D. (NPI 1063469146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225689623 NPI number — PLYOKINETICS THERAPY INC - A PHYSICAL THERAPY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLYOKINETICS THERAPY INC - A PHYSICAL THERAPY CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225689623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25876 THE OLD RD # 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91381-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-731-3293
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13178 ALTA VISTA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-3461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-731-3293
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DE LEON
Authorized Official First Name:
ANGELITO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
818-322-8951

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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