Healthcare Provider Details

I. General information

NPI: 1619308483
Provider Name (Legal Business Name): GOOD FAMILY PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15218 SUMMIT AVE # 300-702
FONTANA CA
92336-0232
US

IV. Provider business mailing address

15218 SUMMIT AVE # 300-702
FONTANA CA
92336-0232
US

V. Phone/Fax

Practice location:
  • Phone: 909-471-8865
  • Fax: 888-544-2759
Mailing address:
  • Phone: 909-471-8865
  • Fax: 888-544-2759

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

VIII. Authorized Official

Name: JOEL ZAMORA
Title or Position: PRESIDENT
Credential: PT
Phone: 909-471-8865