Healthcare Provider Details

I. General information

NPI: 1164518437
Provider Name (Legal Business Name): IEPTSIR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W 6TH ST SUITE 104
CORONA CA
92882-3196
US

IV. Provider business mailing address

1303 W 6TH ST SUITE 104
CORONA CA
92882-3196
US

V. Phone/Fax

Practice location:
  • Phone: 951-273-7742
  • Fax: 951-273-7747
Mailing address:
  • Phone: 951-273-7742
  • Fax: 951-273-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number624596
License Number StateCA

VIII. Authorized Official

Name: CHARLES RICHARD FELDER
Title or Position: OWNER
Credential: MS,PT,SCS,ATC,CSCS
Phone: 951-273-7742