Organization
PRO X PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REVITAL DUER PT (PRESIDENT)
(805) 405-4620
Entity
Organization
Contact information
Practice address
30851 AGOURA RD STE 300A, AGOURA HILLS, CA 91301-4346
(818) 532-7600
Mailing address
192 ODEBOLT DR, THOUSAND OAKS, CA 91360-1736
(805) 405-4620
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
09/21/2018
Last updated
07/16/2024
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