Provider Demographics
NPI:1437929742
Name:ORTHOVIVE PHYSICAL THERAPY & WELLNESS, INC.
Entity type:Organization
Organization Name:ORTHOVIVE PHYSICAL THERAPY & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRIGOR
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:BALASANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-860-4888
Mailing Address - Street 1:12410 BURBANK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4728
Mailing Address - Country:US
Mailing Address - Phone:818-804-4888
Mailing Address - Fax:
Practice Address - Street 1:12410 BURBANK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4728
Practice Address - Country:US
Practice Address - Phone:818-804-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty