Provider Demographics
NPI:1730225525
Name:B&B PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:B&B PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-753-3404
Mailing Address - Street 1:24355 LYONS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2332
Mailing Address - Country:US
Mailing Address - Phone:661-753-3404
Mailing Address - Fax:661-290-2639
Practice Address - Street 1:24355 LYONS AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2332
Practice Address - Country:US
Practice Address - Phone:661-753-3404
Practice Address - Fax:661-290-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47212ZOtherBLUE SHIELD PROVIDER
CA200811901OtherACS PROVIDER NUMBER
CAW15441Medicare PIN
CAZZZ47212ZOtherBLUE SHIELD PROVIDER
CAW15441AMedicare PIN