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General NPI Number Information
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NPI Number | 1003798182
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Entity Type | Organization
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Legal Business Name | JORDAN RIVER PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 34247 YUCAIPA BLVD STE E
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City | YUCAIPA
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State | CA
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Zip | 92399-6118
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Country | US
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Telephone | 909-657-2232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 386
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City | YUCAIPA
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State | CA
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Zip | 92399-0386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | FUAD AL-DABBAK
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Credential |
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Telephone | 909-528-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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