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General NPI Number Information
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NPI Number | 1003099094
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Entity Type | Organization
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Legal Business Name | ADVANTAGE THERAPY INC.
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 1272 CRAGSTONE DR
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City | HEMET
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State | CA
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Zip | 92545-2169
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Country | US
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Telephone | 951-252-5392
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Fax | 888-768-6695
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Provider Business Mailing Address
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Address Line | 1272 CRAGSTONE DRIVE
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City | HEMET
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State | CA
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Zip | 92545
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Country | US
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Telephone | 909-648-1242
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/CEO
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Name | JASON SWISHER
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Credential |
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Telephone | 909-648-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 26133
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License Number State | CA
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