Healthcare Provider Details

I. General information

NPI: 1902025307
Provider Name (Legal Business Name): UNITED THERAPY NETWORK INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BARRANCA ST STE 380
WEST COVINA CA
91791-1637
US

IV. Provider business mailing address

1845 BUSINESS CENTER DRIVE SUITE 127
SAN BERNARDINO CA
92408
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-8355
  • Fax: 626-331-8165
Mailing address:
  • Phone: 909-890-9030
  • Fax: 909-890-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: GUDMUNDUR HEIMIR GUNNARSSON
Title or Position: CEO
Credential: PT
Phone: 909-890-9030