Healthcare Provider Details

I. General information

NPI: 1487651097
Provider Name (Legal Business Name): BODYBASICS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3178 HAMNER AVE STE 4
NORCO CA
92860-1936
US

IV. Provider business mailing address

2275 S MAIN ST STE 102
CORONA CA
92882-5303
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-5646
  • Fax: 951-736-5694
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 StateCA

VIII. Authorized Official

Name: SCOTT HUNSAKER
Title or Position: PRESIDENT
Credential: PT
Phone: 951-736-5646