Healthcare Provider Details

I. General information

NPI: 1407824162
Provider Name (Legal Business Name): RANCHO PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31764 CASINO DR STE 106A&B
LAKE ELSINORE CA
92530-2312
US

IV. Provider business mailing address

600 CENTRAL AVE STE C
LAKE ELSINORE CA
92530-2740
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-3300
  • Fax: 951-471-3301
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA LITT
Title or Position: CREDENTIALING
Credential:
Phone: 951-696-9353