Healthcare Provider Details

I. General information

NPI: 1285190942
Provider Name (Legal Business Name): MARKETPLACE PHYSICAL THERAPY INC, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 MISSION INN AVE STE B
RIVERSIDE CA
92507-4188
US

IV. Provider business mailing address

3191 MISSION INN AVE STE B
RIVERSIDE CA
92507-4188
US

V. Phone/Fax

Practice location:
  • Phone: 951-376-2692
  • Fax: 951-684-2980
Mailing address:
  • Phone: 951-684-2874
  • Fax: 951-684-2980

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: MISS GABRIELA CUBILLAS
Title or Position: CAO
Credential:
Phone: 951-905-8014