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General NPI Number Information
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NPI Number | 1235557950
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Entity Type | Organization
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Legal Business Name | ATHLETIC INSTITUTE AND REHABILITATION
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 25405 HANCOCK AVE
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City | MURRIETA
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State | CA
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Zip | 92562-5982
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Country | US
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Telephone | 909-996-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 9550 PEPPER ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1335
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Country | US
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Telephone | 909-996-6099
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW J BROWN
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Credential | MPT
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Telephone | 909-996-6099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25087
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License Number State | CA
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