Healthcare Provider Details

I. General information

NPI: 1336433408
Provider Name (Legal Business Name): PHYSICAL THERAPY OF TEMECULA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31515 RANCHO PUEBLO RD SUITE 101
TEMECULA CA
92592-4836
US

IV. Provider business mailing address

31515 RANCHO PUEBLO RD SUITE 101
TEMECULA CA
92592-4836
US

V. Phone/Fax

Practice location:
  • Phone: 951-281-2901
  • Fax: 951-281-2902
Mailing address:
  • Phone: 951-281-2901
  • Fax: 951-281-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number20785
License Number StateCA

VIII. Authorized Official

Name: CATHY VO
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-281-2901