Provider Demographics
NPI:1982751640
Name:KENSINGTON PHYSICAL THERAPY
Entity type:Organization
Organization Name:KENSINGTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:MACAULAY
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-358-0215
Mailing Address - Street 1:638 LINDERO CANYON RD
Mailing Address - Street 2:# 506
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-5457
Mailing Address - Country:US
Mailing Address - Phone:805-358-0215
Mailing Address - Fax:805-214-9927
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-358-0215
Practice Address - Fax:805-214-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 15149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty