Healthcare Provider Details

I. General information

NPI: 1003798182
Provider Name (Legal Business Name): JORDAN RIVER PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34247 YUCAIPA BLVD STE E
YUCAIPA CA
92399-6118
US

IV. Provider business mailing address

PO BOX 386
YUCAIPA CA
92399-0386
US

V. Phone/Fax

Practice location:
  • Phone: 909-657-2232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FUAD AL-DABBAK
Title or Position: MANAGER
Credential:
Phone: 909-528-8288