Healthcare Provider Details

I. General information

NPI: 1992399406
Provider Name (Legal Business Name): BODYBASICS PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14252 SCHLEISMAN RD STE 203
EASTVALE CA
92880-4020
US

IV. Provider business mailing address

14252 SCHLEISMAN RD STE 203
EASTVALE CA
92880-4020
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 Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT HUNSAKER
Title or Position: PRESIDENT
Credential: PT
Phone: 951-273-7742