Healthcare Provider Details

I. General information

NPI: 1912288309
Provider Name (Legal Business Name): RANCHO PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 BROCKTON AVE STE 212
RIVERSIDE CA
92506-3815
US

IV. Provider business mailing address

30428 HAUN RD STE 810
MENIFEE CA
92584-6824
US

V. Phone/Fax

Practice location:
  • Phone: 951-534-0600
  • Fax: 951-534-0605
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GABRIELA LITT
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 951-696-9353