Healthcare Provider Details

I. General information

NPI: 1023954971
Provider Name (Legal Business Name): RANCHO MIRAGE OUTPATIENT PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35280 BOB HOPE DR STE 103
RANCHO MIRAGE CA
92270-1753
US

IV. Provider business mailing address

35280 BOB HOPE DR STE 103
RANCHO MIRAGE CA
92270-1753
US

V. Phone/Fax

Practice location:
  • Phone: 440-444-8888
  • Fax:
Mailing address:
  • Phone: 440-444-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AVETIK HOVHANNISYAN
Title or Position: CEO/OWNER
Credential:
Phone: 440-444-8888