MEDICARE: IEPTSIR, 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	261QP2000X	Physical Therapy Clinic/Center	624596	CA

General Provider Information

NPI Number	:	1164518437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IEPTSIR, INC.

Provider Business Mailing Address
First Line	:	1303 W 6TH ST
Second Line	:	SUITE 104
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-273-7742
Fax Number	:	951-273-7747

Provider Business Practice Location Address
First Line	:	1303 W 6TH ST
Second Line	:	SUITE 104
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-273-7742
Fax Number	:	951-273-7747

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES RICHARD FELDER
Credential	:	MS,PT,SCS,ATC,CSCS
Telephone Number	:	951-273-7742

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

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Directions to “IEPTSIR, INC. ” Practice Location

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