Provider Demographics
NPI:1063745842
Name:CONEJO VALLEY PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:CONEJO VALLEY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VONARB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-497-9300
Mailing Address - Street 1:90 E THOUSAND OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5761
Mailing Address - Country:US
Mailing Address - Phone:805-497-9300
Mailing Address - Fax:805-497-9311
Practice Address - Street 1:90 E THOUSAND OAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5761
Practice Address - Country:US
Practice Address - Phone:805-497-9300
Practice Address - Fax:805-497-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14444261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy