Healthcare Provider Details

I. General information

NPI: 1316534399
Provider Name (Legal Business Name): INDEPENDENT REHAB PHYSIOTHERAPY STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N PLYMOUTH WAY
SAN BERNARDINO CA
92408-4173
US

IV. Provider business mailing address

PO BOX 766
LOMA LINDA CA
92354-0766
US

V. Phone/Fax

Practice location:
  • Phone: 909-800-3749
  • Fax:
Mailing address:
  • Phone: 909-800-3749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KABBYO CHAWDHURY
Title or Position: HEAD THERAPIST
Credential: DPT
Phone: 909-800-3749