MEDICARE: ONWARD PHYSICAL THERAPY AND WELLNESS CENTER

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	35363	CA

General Provider Information

NPI Number	:	1811260987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONWARD PHYSICAL THERAPY AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	4434 INGRAHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4404
Country	:	US
Telephone Number	:	619-202-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	4434 INGRAHAM ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4404
Country	:	US
Telephone Number	:	619-202-7602
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/PHYSICAL THERAPIST
Name	:	DR. MELODY STEVENS
Credential	:	PT, DPT
Telephone Number	:	909-772-2862

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	06/23/2014

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