Healthcare Provider Details

I. General information

NPI: 1609407949
Provider Name (Legal Business Name): REDHAWK PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31537 RANCHO PUEBLO RD STE 204
TEMECULA CA
92592-4841
US

IV. Provider business mailing address

31537 RANCHO PUEBLO RD STE 204
TEMECULA CA
92592-4841
US

V. Phone/Fax

Practice location:
  • Phone: 951-514-0728
  • Fax: 951-639-0153
Mailing address:
  • Phone: 951-514-0728
  • Fax: 951-639-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIA CHRISTINE SCIRA
Title or Position: CEO
Credential: PT
Phone: 951-514-0728