Provider Demographics
NPI:1902930894
Name:RELIEF PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RELIEF PHYSICAL THERAPY
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:661-298-0140
Mailing Address - Street 1:28200 BOUQUET CANYON RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1400
Mailing Address - Country:US
Mailing Address - Phone:661-298-0140
Mailing Address - Fax:661-298-1207
Practice Address - Street 1:28200 BOUQUET CANYON RD
Practice Address - Street 2:UNIT E
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-1400
Practice Address - Country:US
Practice Address - Phone:661-298-0140
Practice Address - Fax:661-298-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16807261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT16807OtherMEDICARE PROVIDER NUMBER