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General NPI Number Information
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NPI Number | 1245661024
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Entity Type | Organization
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Legal Business Name | FORM AND FUNCTION PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 12067 ARROW RTE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9219
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Country | US
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Telephone | 888-619-2885
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Fax | 909-784-1995
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Provider Business Mailing Address
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Address Line | PO BOX 896
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City | CHINO HILLS
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State | CA
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Zip | 91709-0030
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Country | US
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Telephone | 888-619-2885
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Fax | 909-784-1995
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Authorized Official
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Title or Position | DIRECTOR
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Name | TREVOR FIELD
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Credential |
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Telephone | 888-619-2885
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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 | CA
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