Healthcare Provider Details

I. General information

NPI: 1972617025
Provider Name (Legal Business Name): VALLEY OF IMPERIAL PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 G ST
BRAWLEY CA
92227-2411
US

IV. Provider business mailing address

578 G ST
BRAWLEY CA
92227-2411
US

V. Phone/Fax

Practice location:
  • Phone: 760-355-4537
  • Fax: 760-344-7106
Mailing address:
  • Phone: 760-355-4537
  • Fax: 760-344-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT10131
License Number StateCA

VIII. Authorized Official

Name: ZENAIDA S SANTOS
Title or Position: PRESIDENT
Credential: RPT
Phone: 760-344-2157