1902208507 NPI number — PREMIER PHYSICAL THERAPY & ASSOCIATES INC

Table of content: (NPI 1902208507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902208507 NPI number — PREMIER PHYSICAL THERAPY & ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PHYSICAL THERAPY & ASSOCIATES INC
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:
1902208507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 N VENTURA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-566-0600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6591 COLLINS DR STE E8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-517-0151
Provider Business Practice Location Address Fax Number:
805-517-0231
Provider Enumeration Date:
09/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
805-566-0600

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  20274 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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