Provider Demographics
NPI:1447322789
Name:STEVEN DANCHIK PHYSICAL THERAPY PT5208
Entity type:Organization
Organization Name:STEVEN DANCHIK PHYSICAL THERAPY PT5208
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-909-7038
Mailing Address - Street 1:PO BOX 940369
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0369
Mailing Address - Country:US
Mailing Address - Phone:818-909-7038
Mailing Address - Fax:805-526-3597
Practice Address - Street 1:15333 SHERMAN WAY
Practice Address - Street 2:SUITE P
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4206
Practice Address - Country:US
Practice Address - Phone:818-909-7038
Practice Address - Fax:818-909-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEMPLOYER TAX ID NUMBER
CAW18801Medicare ID - Type Unspecified
CA=========OtherEMPLOYER TAX ID NUMBER