MEDICARE: RANCHO PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ01577Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1164490454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	30428 HAUN RD STE 810
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92584-6824
Country	:	US
Telephone Number	:	951-696-9353
Fax Number	:	951-973-7216

Provider Business Practice Location Address
First Line	:	38605 CALISTOGA DR
Second Line	:	SUITE 140
City	:	MURRIETA
State	:	CA
Zip	:	92563-4820
Country	:	US
Telephone Number	:	951-304-0879
Fax Number	:	951-304-1459

Authorized Official
Title or Position	:	PROVIDER RELATIONS SUPERVISOR
Name	:	GABRIELA LITT
Credential	:
Telephone Number	:	951-696-9353

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/14/2025

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