Healthcare Provider Details

I. General information

NPI: 1629693619
Provider Name (Legal Business Name): UNITED THERAPY NETWORK INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CENTRAL AVE STE 145
RIVERSIDE CA
92506-2161
US

IV. Provider business mailing address

1845 BUSINESS CENTER DR STE 127
SAN BERNARDINO CA
92408-3434
US

V. Phone/Fax

Practice location:
  • Phone: 951-297-3399
  • Fax: 951-297-3404
Mailing address:
  • Phone: 909-890-9030
  • Fax: 909-890-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. GUDMUNDUR HEIMER GUNNARSSON
Title or Position: PT AND OWNER
Credential: PT, CEO
Phone: 909-890-9030