Healthcare Provider Details

I. General information

NPI: 1942519178
Provider Name (Legal Business Name): PETER CHRISTOPHER LINGAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 COMMERCIAL RD
SAN BERNARDINO CA
92408-3708
US

IV. Provider business mailing address

394 COMMERCIAL RD
SAN BERNARDINO CA
92408-3708
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-7700
  • Fax:
Mailing address:
  • Phone: 909-796-7700
  • Fax: 909-796-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: