Provider Demographics
NPI:1447534300
Name:PHILLIPS, BETH JO (PT, DPA)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:JO
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT, DPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 VANTAGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:818-677-2203
Mailing Address - Fax:818-677-7411
Practice Address - Street 1:KLOTZ STUDENT HEALTH CTR
Practice Address - Street 2:18111 NORDHOFF STREET
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-0001
Practice Address - Country:US
Practice Address - Phone:818-677-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT215982251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic