Healthcare Provider Details

I. General information

NPI: 1992660955
Provider Name (Legal Business Name): LIFTED PERFORMANCE PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 GOLD MEDAL LN
REDLANDS CA
92374-1415
US

IV. Provider business mailing address

1736 GOLD MEDAL LN
REDLANDS CA
92374-1415
US

V. Phone/Fax

Practice location:
  • Phone: 909-801-9231
  • Fax:
Mailing address:
  • Phone: 909-801-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL I KARIM
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 909-801-9231