Organization
LIGHTHOUSE PHYSICAL THERAPY REHAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILIO VALDES (OWNER)
(818) 956-0010
Entity
Organization
Contact information
Practice address
1314 W GLENOAKS BLVD, 204, GLENDALE, CA 91201-1978
(818) 956-0010
(818) 956-0040
Mailing address
1314 W GLENOAKS BLVD, 204, GLENDALE, CA 91201-1978
(818) 956-0010
(818) 956-0040
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT13519
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14256
MEDICAL LICENSE
CA
Enumeration date
10/16/2013
Last updated
02/05/2014
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