Healthcare Provider Details

I. General information

NPI: 1205869070
Provider Name (Legal Business Name): TEAM PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 HAVEN AVE
RANCHO CUCAMONGA CA
91730-3066
US

IV. Provider business mailing address

10590 TOWN CENTER DR STE 100
RANCHO CUCAMONGA CA
91730-0361
US

V. Phone/Fax

Practice location:
  • Phone: 909-948-1124
  • Fax: 909-948-1104
Mailing address:
  • Phone: 909-948-1124
  • Fax: 909-948-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT14201
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFREY T BEKENDAM
Title or Position: OWNER/DIRECTOR
Credential: PT
Phone: 909-948-1124