Healthcare Provider Details

I. General information

NPI: 1205685203
Provider Name (Legal Business Name): ENVISION PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 CONDOR DR
RIVERSIDE CA
92509-0417
US

IV. Provider business mailing address

6613 CONDOR DR
RIVERSIDE CA
92509-0417
US

V. Phone/Fax

Practice location:
  • Phone: 909-254-7399
  • Fax:
Mailing address:
  • Phone: 909-254-7399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS THOI CHAU DUONG
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 909-254-7399