Provider Demographics
NPI:1396997557
Name:J. V. THERAPY SERVICES INC.
Entity type:Organization
Organization Name:J. V. THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVANCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-899-5555
Mailing Address - Street 1:12502 VAN NUYS BLVD
Mailing Address - Street 2:104
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1321
Mailing Address - Country:US
Mailing Address - Phone:818-899-5555
Mailing Address - Fax:818-899-5969
Practice Address - Street 1:12502 VAN NUYS BLVD
Practice Address - Street 2:107
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1321
Practice Address - Country:US
Practice Address - Phone:818-899-5555
Practice Address - Fax:818-899-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT0203060261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0203060Medicaid