Healthcare Provider Details

I. General information

NPI: 1932045465
Provider Name (Legal Business Name): STEM CELL PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 VINEYARD AVE STE D1
RANCHO CUCAMONGA CA
91730-2314
US

IV. Provider business mailing address

17918 IOLITE LOOP
SAN BERNARDINO CA
92407-0444
US

V. Phone/Fax

Practice location:
  • Phone: 909-727-3020
  • Fax: 909-727-3001
Mailing address:
  • Phone: 909-420-5752
  • Fax: 909-727-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICE WATSON
Title or Position: OWNER/CEO
Credential: OTR/L
Phone: 909-727-3020