Healthcare Provider Details
I. General information
NPI: 1679713135
Provider Name (Legal Business Name): INTEGRITY PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
647 SHENANDOAH RD
CORONA CA
92879-8509
US
IV. Provider business mailing address
647 SHENANDOAH RD
CORONA CA
92879-8509
US
V. Phone/Fax
- Phone: 951-310-1130
- Fax: 877-563-5027
- Phone: 951-310-1130
- Fax: 877-563-5027
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QP2000X |
| Taxonomy | Physical Therapy Clinic/Center |
| License Number | PT25778 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QR0401X |
| Taxonomy | Comprehensive Outpatient Rehabilitation Facility (CORF) |
| License Number | PT25778 |
| License Number State | CA |
VIII. Authorized Official
Name: MRS.
DONNA
LEE
PINEDA-FALDAS
Title or Position: CEO
Credential: PT
Phone: 951-310-1130