Active NPI
Athletic Physical Therapy
- Physical Therapist
- Encino, CA
National Provider Identifier
1467684225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- ATHLETIC PHYSICAL THERAPY
- Practice address
- 5353 Balboa Blvd
202
Encino, CA 91316-2804 - Phone
- (818) 986-4100
- NPI assigned
- Aug 12, 2009
- Last updated
- Aug 12, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Stephen Clark, DPT
- Title
- President
- Phone
- (818) 340-2002
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | Primary |
Addresses
Primary practice location
5353 Balboa Blvd
202
Encino, CA 91316-2804
Mailing address
30877 Thousand Oaks Blvd
Westlake Village, CA 91362-4039
Phone (818) 879-2091
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041202000150 | CA | Part B Supplier - Clinic/Group Practice | 6507821436 |
Receives reassigned benefits from 11 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Los Angeles, CA; Simi Valley, CA; Westlake Village, CA |
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Physical Therapist
- Westlake Village, CA
- NPI 1114042165
O20041202000150
National Provider Directory
National Provider DirectoryLocations
5353 Balboa Blvd
Ste 202
Encino, CA 91316
Phone (818) 501-7276
30877 E Thousand Oaks Blvd
Westlake Village, CA 91362
Phone (818) 340-2002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250035200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1250035200000",
"number": "1467684225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30877 THOUSAND OAKS BLVD",
"city": "WESTLAKE VILLAGE",
"state": "CA",
"postal_code": "913624039",
"telephone_number": "818-879-2091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5353 BALBOA BLVD",
"address_2": "202",
"city": "ENCINO",
"state": "CA",
"postal_code": "913162804",
"telephone_number": "818-986-4100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ATHLETIC PHYSICAL THERAPY",
"organizational_subpart": "NO",
"enumeration_date": "2009-08-12",
"last_updated": "2009-08-12",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "STEPHEN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "818-340-2002",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "DPT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.