MEDICARE: GOOD FAMILY 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1619308483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD FAMILY PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	15218 SUMMIT AVE # 300-702
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-471-8865
Fax Number	:	888-544-2759

Provider Business Practice Location Address
First Line	:	15218 SUMMIT AVE # 300-702
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-471-8865
Fax Number	:	888-544-2759

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL ZAMORA
Credential	:	PT
Telephone Number	:	909-471-8865

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	12/04/2013

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Directions to “GOOD FAMILY PHYSICAL THERAPY INC ” Practice Location

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