Healthcare Provider Details

I. General information

NPI: 1043304942
Provider Name (Legal Business Name): TOTAL WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 B MISSION INN AVE
RIVERSIDE CA
92507
US

IV. Provider business mailing address

3191 B MISSION INN AVE
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-2874
  • Fax: 951-684-2980
Mailing address:
  • Phone: 951-684-2874
  • Fax: 951-684-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT12634
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28089
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL DAVID RAPPAPORT
Title or Position: OWNER PRESIDENT
Credential: MBA
Phone: 951-684-2874