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General NPI Number Information
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NPI Number | 1043852528
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Entity Type | Organization
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Legal Business Name | PHOENIX PHYSICAL THERAPY AND WELLNESS INC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 9555 FOOTHILL BLVD STE A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3576
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Country | US
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Telephone | 909-466-7363
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Fax |
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Provider Business Mailing Address
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Address Line | 11042 CHARLESTON ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-7714
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Country | US
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Telephone | 818-300-7169
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Fax | 909-466-7365
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Authorized Official
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Title or Position | CEO
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Name | DR. PEYMAN NASSERI
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Credential | DPT
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Telephone | 909-466-7363
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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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