Healthcare Provider Details

I. General information

NPI: 1194667857
Provider Name (Legal Business Name): BOON PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 LOYOLA CT.
CHINO CA
91710
US

IV. Provider business mailing address

4900 CALIFORNIA AVE STE 210B
BAKERSFIELD CA
93309-7080
US

V. Phone/Fax

Practice location:
  • Phone: 877-472-2261
  • Fax: 877-349-1138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANNIKA LUCAS
Title or Position: OWNER
Credential:
Phone: 530-386-4608