Organization
DIVINE HEALTH PROVIDER PHYSICAL THERAPY INC
Active
Other names
Simi Physical Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONAH TAN MPT, PA-C (DIRECTOR)
(805) 581-4266
Entity
Organization
Contact information
Practice address
1687 ERRINGER RD STE 109, SIMI VALLEY, CA 93065-6509
(805) 581-4266
(805) 581-5049
Mailing address
1687 ERRINGER RD STE 109, SIMI VALLEY, CA 93065-6509
(805) 581-4266
(805) 581-5049
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT24912
CA
Other
Enumeration date
11/26/2008
Last updated
07/21/2022
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