Healthcare Provider Details

I. General information

NPI: 1063130235
Provider Name (Legal Business Name): NDR THERAPEUTIC RIDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 PEDLEY AVE
NORCO CA
92860-1597
US

IV. Provider business mailing address

3659 PEDLEY AVE
NORCO CA
92860-1597
US

V. Phone/Fax

Practice location:
  • Phone: 951-253-8563
  • Fax:
Mailing address:
  • Phone: 951-253-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA HYDE
Title or Position: EXECUTIVE DIRECTOR
Credential: CTRI
Phone: 951-283-3967