Healthcare Provider Details

I. General information

NPI: 1073156964
Provider Name (Legal Business Name): WINGS PHYSIOTHERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18231 US HIGHWAY 18 STE 3
APPLE VALLEY CA
92307-2213
US

IV. Provider business mailing address

688 WOODLAWN AVE
SAN BERNARDINO CA
92407-1026
US

V. Phone/Fax

Practice location:
  • Phone: 909-659-5708
  • Fax: 909-913-4851
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY REUL
Title or Position: PRESIDENT
Credential:
Phone: 760-221-5079