Healthcare Provider Details

I. General information

NPI: 1720206782
Provider Name (Legal Business Name): HOLTVILLE THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 5TH ST
HOLTVILLE CA
92250-1214
US

IV. Provider business mailing address

110 W 5TH ST
HOLTVILLE CA
92250-1214
US

V. Phone/Fax

Practice location:
  • Phone: 760-455-3306
  • Fax: 760-344-8240
Mailing address:
  • Phone: 760-455-3306
  • Fax: 760-344-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUN GARCIA
Title or Position: OWNER
Credential: PTA
Phone: 760-455-3306