Provider Demographics
NPI:1528131489
Name:BURBANK PHYSICAL THERAPY & WELLNESS INC
Entity type:Organization
Organization Name:BURBANK PHYSICAL THERAPY & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAMONDONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:213-924-0929
Mailing Address - Street 1:213 W ALAMEDA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-3027
Mailing Address - Country:US
Mailing Address - Phone:818-566-8443
Mailing Address - Fax:818-566-8434
Practice Address - Street 1:213 W ALAMEDA AVE STE 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-3027
Practice Address - Country:US
Practice Address - Phone:818-566-8443
Practice Address - Fax:818-566-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty